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. 2022 Jul;24(7):1305-1315.
doi: 10.1002/ejhf.2526. Epub 2022 May 24.

Improved survival of left ventricular assist device carriers in Europe according to implantation eras: results from the PCHF-VAD registry

Nina Jakus  1 , Jasper J Brugts  2 , Brian Claggett  3 , Philippe Timmermans  4 , Anne-Catherine Pouleur  5   6 , Pawel Rubiś  7 , Emeline M Van Craenenbroeck  8 , Edvinas Gaizauskas  9 , Eduardo Barge-Caballero  10 , Stefania Paolillo  11 , Sebastian Grundmann  12 , Domenico D'Amario  13 , Oscar Ö Braun  14 , Aggeliki Gkouziouta  15 , Bart Meyns  16 , Walter Droogne  4 , Karol Wierzbicki  17 , Katarzyna Holcman  7 , Ivo Planinc  1 , Bosko Skoric  1 , Andreas J Flammer  18 , Hrvoje Gasparovic  19 , Bojan Biocina  19 , Lars H Lund  20 , Davor Milicic  1 , Frank Ruschitzka  18 , Maja Cikes  1 ; PCHF-VAD registry
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Free article

Improved survival of left ventricular assist device carriers in Europe according to implantation eras: results from the PCHF-VAD registry

Nina Jakus et al. Eur J Heart Fail. 2022 Jul.
Free article

Abstract

Aims: Temporal changes in patient selection and major technological developments have occurred in the field of left ventricular assist devices (LVADs), yet analyses depicting this trend are lacking for Europe. We describe the advances of European LVAD programmes from the PCHF-VAD registry across device implantation eras.

Methods and results: Of 583 patients from 13 European centres in the registry, 556 patients (mean age 53 ± 12 years, 82% male) were eligible for this analysis. Patients were divided into eras (E) by date of LVAD implantation: E1 from December 2006 to December 2012 (6 years), E2 from January 2013 to January 2020 (7 years). Patients implanted more recently were older with more comorbidities, but less acutely ill. Receiving an LVAD in E2 was associated with improved 1-year survival in adjusted analysis (hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.35-0.98; p = 0.043). LVAD implantation in E2 was associated with a significantly lower chance of heart transplantation (adjusted HR 0.40, 95% CI 0.23-0.67; p = 0.001), and lower risk of LVAD-related infections (adjusted HR 0.64, 95% CI 0.43-0.95; p = 0.027), both in unadjusted and adjusted analyses. The adjusted risk of haemocompatibility-related events decreased (HR 0.60, 95% CI 0.39-0.91; p = 0.016), while heart failure-related events increased in E2 (HR 1.67, 95% CI 1.02-2.75; p = 0.043).

Conclusion: In an analysis depicting the evolving landscape of continuous-flow LVAD carriers in Europe over 13 years, a trend towards better survival was seen in recent years, despite older recipients with more comorbidities, potentially attributable to increasing expertise of LVAD centres, improved patient selection and pump technology. However, a smaller chance of undergoing heart transplantation was noted in the second era, underscoring the relevance of improved outcomes on LVAD support.

Keywords: Advanced heart failure; Comorbidities; Heart transplantation; Left ventricular assist device; Survival.

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References

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