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. 2024 Sep 30;16(9):6037-6044.
doi: 10.21037/jtd-24-514. Epub 2024 Sep 18.

Trends and predictors of functional class after high-risk left ventricular assist device implantation at a destination therapy center

John B Eisenga  1   2   3 , Kyle A McCullough  1   2 , Aasim Afzal  4 , J Michael DiMaio  1   5 , Ghadi Moubarak  1   2 , Greg Milligan  1 , Nitin Kabra  1 , Akash Rusia  1 , David A Rawitscher  1 , Timothy J George  1
Affiliations

Trends and predictors of functional class after high-risk left ventricular assist device implantation at a destination therapy center

John B Eisenga et al. J Thorac Dis. .

Abstract

Background: Although left ventricular assist device (LVAD) implantation is associated with improved survival, long-term impact on functional class is less well understood in high-risk implants. We undertook this study to better understand how destination therapy (DT) LVAD implantation affects patient functional status and predictors of functional improvement.

Methods: We conducted a single-center, retrospective review of all primary LVAD implantations. Primary outcome was New York Heart Association (NYHA) functional class. An improved sustainable functional improvement was defined as being alive at 1-year with NYHA class I or II symptoms. Multivariable logistic regression was performed to identify predictors of sustainable functional improvement.

Results: From 2017 to 2023, 151 primary LVAD implantations were performed. Operative mortality was 7.95% (n=12). At 6-month follow-up, 113 (92.62%) of patients had experienced an improvement in functional class with 35 (28.69%) class I, 53 (43.44%) class II, 29 (23.77%) class III, and 5 (4.10%) class IV. At 12 months, 86 (91.49%) patients had sustained improvement in NYHA class with 32 (34.04%) class I, 40 (42.55%) class II, 19 (20.21%) class III, and 3 (3.19%) class IV. At 2 years, 57 (91.94%) patients still experienced improved symptoms. On multivariable logistic regression analysis, an ischemic etiology of heart failure (HF) was associated with a sustainable functional improvement [odds ratio: 5.53 (95% confidence interval: 1.06-28.89), P=0.04].

Conclusions: LVAD implantation is associated with significant functional improvement as measured by NYHA class. The high-risk cohort showed similar improvement in functional status. In our series, the best predictor of a sustainable improvement in functional status is an ischemic etiology of HF.

Keywords: Left ventricular assist device (LVAD); New York Heart Association (NYHA); functional status; heart failure (HF); outcomes.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-514/coif). A.A. and T.J.G. are part of the Abiomed speaker’s bureau. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Two-year Kaplan-Meier survival curve.
Figure 2
Figure 2
Distribution of NYHA functional class over time. NYHA, New York Heart Association; LVAD, left ventricular assist device.
Figure 3
Figure 3
NYHA functional class at 1-year stratified by preoperative and postoperative patient characteristics and complications. NYHA, New York Heart Association; eGFR, estimated glomerular filtration rate; BMI, body mass index; RVAD, right ventricular assist device.
See this image and copyright information in PMC

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