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. 2021 Dec;8(6):5159-5167.
doi: 10.1002/ehf2.13592. Epub 2021 Sep 7.

Characteristics and outcome of ambulatory heart failure patients receiving a left ventricular assist device

Guillaume Baudry  1 , Nicolas Nesseler  2 , Erwan Flecher  2 , André Vincentelli  3 , Céline Goeminne  3 , Clément Delmas  4 , Jean Porterie  4 , Karine Nubret  5 , Mathieu Pernot  5 , Michel Kindo  6 , Tam Hoang Minh  6 , Philippe Rouvière  7 , Philippe Gaudard  7 , Magali Michel  8 , Thomas Senage  8 , Aude Boignard  9 , Olivier Chavanon  9 , Marylou Para  10 , Constance Verdonk  10 , Edeline Pelcé  11 , Vlad Gariboldi  11 , Frederic Anselme  12 , Pierre-Yves Litzler  12 , Katrien Blanchart  13 , Gerard Babatasi  13 , Marie Bielefeld  14 , Olivier Bouchot  14 , David Hamon  15 , Nicolas Lellouche  15 , Xavier Bailleul  16 , Thibaud Genet  16 , Romain Eschalier  17 , Nicolas d'Ostrevy  17 , Marie-Cécile Bories  18 , Ramzi Abi Akar  18 , Hugues Blangy  19 , Fabrice Vanhuyse  19 , Jean François Obadia  20 , Vincent Galand  2 , Matteo Pozzi  20
Affiliations

Characteristics and outcome of ambulatory heart failure patients receiving a left ventricular assist device

Guillaume Baudry et al. ESC Heart Fail. 2021 Dec.

Abstract

Aims: Despite regularly updated guidelines, there is still a delay in referral of advanced heart failure patients to mechanical circulatory support and transplant centres. We aimed to analyse characteristics and outcome of non-inotrope-dependent patients implanted with a left ventricular assist device (LVAD).

Methods and results: The ASSIST-ICD registry collected LVAD data in 19 centres in France between February 2006 and December 2016. We used data of patients in Interagency Registry for Mechanically Assisted Circulatory Support Classes 4-7. The primary endpoint was survival analysis. Predictors of mortality were searched with multivariable analyses. A total of 303 patients (mean age 61.0 ± 9.9 years, male sex 86.8%) were included in the present analysis. Ischaemic cardiomyopathy was the leading heart failure aetiology (64%), and bridge to transplantation was the main implantation strategy (56.1%). The overall likelihood of being alive while on LVAD support or having a transplant at 1, 2, 3, and 5 years was 66%, 61.7%, 58.7%, and 55.1%, respectively. Age [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.00-1.05; P = 0.02], a concomitant procedure (HR 2.32, 95% CI 1.52-3.53; P < 0.0001), and temporary mechanical right ventricular support during LVAD implantation (HR 2.94, 95% CI 1.49-5.77; P = 0.002) were the only independent variables associated with mortality. Heart failure medications before or after LVAD implantation were not associated with survival.

Conclusion: Ambulatory heart failure patients displayed unsatisfactory survival rates after LVAD implantation. A better selection of patients who can benefit from LVAD may help improving outcomes.

Keywords: Advanced heart failure; Heart failure medications; Left ventricular assist device; Mechanical circulatory support; Outcome measures.

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Conflict of interest statement

G.B. is a consultant for Boehringer Ingelheim, AstraZeneca, and Abbott outside the submitted work. The remaining authors have nothing to disclose.

Figures

Figure 1
Figure 1
Competing events after left ventricular assist device (LVAD) implantation. Mutually exclusive endpoints of death, alive on ventricular assist device, or transplant were tracked through 5 years, with the cumulative percentage of events at any given time point equal to 100%.
See this image and copyright information in PMC

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