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. 2022 Aug 20;11(16):4901.
doi: 10.3390/jcm11164901.

A Device Strategy-Matched Comparison Analysis among Different Intermacs Profiles: A Single Center Experience

Raphael Caraffa  1 , Jonida Bejko  1 , Massimiliano Carrozzini  1 , Olimpia Bifulco  1 , Vincenzo Tarzia  1 , Giulia Lorenzoni  2 , Daniele Bottigliengo  2 , Dario Gregori  2 , Chiara Castellani  3 , Tomaso Bottio  1 , Annalisa Angelini  3 , Gino Gerosa  1
Affiliations

A Device Strategy-Matched Comparison Analysis among Different Intermacs Profiles: A Single Center Experience

Raphael Caraffa et al. J Clin Med. .

Abstract

Background: The present study evaluates outcomes of LVAD patients, taking into account the device strategy and the INTERMACS profile. Methods: We included 192 LVAD-patients implanted between January 2012 and May 2021. The primary and secondary end-points were survival and major adverse events between Profiles 1-3 vs. Profile 4, depending on implantation strategies (Bridge-to-transplant-BTT; Bridge-to-candidacy-BTC; Destination-Therapy-DT). Results: The overall survival was 67% (61-75) at 12 months and 61% (54-70) at 24 months. Profile 4 patients showed significantly higher survival (p = 0.018). Incidences of acute right-ventricular-failure (RVF) (p = 0.046), right-ventricular-assist-device (RVAD) implantation (p = 0.015), and continuous-venovenous-hemofiltration (CVVH) (p = 0.006) were higher in Profile 1-3 patients, as well as a longer intensive care unit stays (p = 0.050) and in-hospital-mortality (p = 0.012). Twelve-month and 24-month survival rates were higher in the BTT rather than in BTC (log-rank = 0.410; log-rank = 0.120) and in DT groups (log-rank = 0.046). In the BTT group, Profile 1-3 patients had a higher need for RVAD support (p = 0.042). Conclusions: LVAD implantation in elective patients was associated with better survival and lower complications incidence. LVAD implantation in BTC patients has to be considered before their conditions deteriorate. DT should be addressed to elective patients in order to guarantee acceptable results.

Keywords: device strategy; heart failure; left ventricular assist device; mechanical circulatory support.

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Conflict of interest statement

All authors have no conflict of interest or financial conflict to disclose.

Figures

Figure 1
Figure 1
Overall Survival. Patients were censored at time of transplant or last follow-up.
Figure 2
Figure 2
Kaplan-Meier analysis of survival stratified by baseline INTERMACS patient profile.
Figure 3
Figure 3
Kaplan-Meier analysis of survival stratified by different implantation strategies.
Figure 4
Figure 4
Kaplan–Meier analysis of survival among INTERMACS Profile 1–3 and Profile 4 BTT patients.
Figure 5
Figure 5
Competing risk analysis in BTT patients: curves are used to represent the cumulative risk of a patient during the time of being alive, transplanted, or dead.
Figure 6
Figure 6
Kaplan–Meier analysis of survival among INTERMACS Profile 1–3 and Profile 4 BTC patients.
Figure 7
Figure 7
Kaplan-Meier analysis of survival among INTERMACS Profile 1–3 and Profile 4 DT patients.
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