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Thorac Cardiovasc Surg
DOI: 10.1055/s-0044-1782600
Original Cardiovascular

Temporal Analysis in Outcomes of Long-Term Mechanical Circulatory Support: Retrospective Study

Matej Ondrusek
1   Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
,
Panagiotis Artemiou
1   Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
,
Branislav Bezak
1   Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
,
Ivo Gasparovic
1   Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
,
Theo MMH de By
2   EUROMACS, European Association for Cardio-Thoracic Surgery (EACTS), Windsor, United Kingdom
,
Stefan Durdik
3   Faculty of Medicine, Comenius University, St. Elizabeth Oncology Institute, Clinic of Surgical Oncology, Bratislava, Slovakia
,
Peter Lesny
4   Faculty of Medicine of the Comenius University, National Institute of Cardiovascular Diseases, Clinic of Heart Failure, Bratislava, Slovakia
,
Eva Goncalvesova
4   Faculty of Medicine of the Comenius University, National Institute of Cardiovascular Diseases, Clinic of Heart Failure, Bratislava, Slovakia
,
Michal Hulman
1   Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
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Abstract

Background Mechanical assist device indications have changed in recent years. Reduced incidence of complications, better survival, and the third generation of mechanical support devices contributed to this change. In this single-center study, we focused on two time periods that are characterized by the use of different types of mechanical support devices, different patient characteristics, and change in the indications.

Methods The data were processed from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). We retrospectively defined two time intervals to reflect changes in ventricular assist device technology (period 1: 2007–2015; period 2: 2016–20222). A total of 181 patients underwent left ventricular assist device implantation. Device utilization was the following: HeartMate II = 52 (76.4%) and HeartWare = 16 (23.6%) in period 1 and HeartMate II = 2 (1.8%), HeartMate 3 = 70 (61:9%), HeartWare = 29 (25.7%), SynCardia TAH = 10 (8.8%), and BerlinHeart EXCOR = 2 (1.8%) in period 2. The outcomes of the time intervals were analyzed and evaluated.

Results Survival was significantly higher during the second time period. Multivariate analysis revealed that age and bypass pump time are independent predictors of mortality. Idiopathic cardiomyopathy, bypass time, and the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score are independent predictors of adverse events. Furthermore, the first period was noted to be at an increased risk of the following adverse events: pump thrombosis, gastrointestinal bleeding, and bleeding events.

Conclusion Despite the higher risk profile of the patients and persistent challenges, during the second period, there was a significant decrease in mortality and morbidity. The use of the HeartMate 3 device may have contributed to this result.

Keywords

left ventricular assist device - outcomes - temporal analysis

Authors' Contribution

E.G. and P.L. were added as co-authors during the revision process. Both of them had a significant contribution in the preparation of the revised manuscript. The individual contributions were the following: P.L. contributed to the drafting and writing part of the revised manuscript. E.G. contributed to the drafting and writing part of the revised manuscript, and supervision.




Publication History

Received: 16 October 2023

Accepted: 12 February 2024

Article published online:
19 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Toro S, Patel K, Guha A. Destination LVAD therapy in the current era of the heart transplant allocation system. Curr Opin Cardiol 2023; 38 (03) 275-279
    CrossrefPubMedGoogle Scholar
  • 2 Molina EJ, Shah P, Kiernan MS. et al. The Society of Thoracic Surgeons INTERMACS 2020 Annual Report. Ann Thorac Surg 2021; 111 (03) 778-792
    CrossrefPubMedGoogle Scholar
  • 3 Goncalvesova E a kolektiv. Manual diagnostických indikačných a liečebných postupov. Účelová publikácia NUSCH, a.s. Herba; 2022
    Google Scholar
  • 4 McElreath R. Statistical Rethinking: A Bayesian Course with Examples in R and Stan. Boca Raton, FL:: CRC Press;; 2016: 189
    Google Scholar
  • 5 Varshney AS, DeFilippis EM, Cowger JA, Netuka I, Pinney SP, Givertz MM. Trends and outcomes of left ventricular assist device therapy: JACC focus seminar. J Am Coll Cardiol 2022; 79 (11) 1092-1107
    CrossrefPubMedGoogle Scholar
  • 6 Mehra MR, Nayak A, Morris AA. et al. Prediction of survival after implantation of a fully magnetically levitated left ventricular assist devive. JACC Heart Fail 2022; 10 (12) 948-959
    CrossrefPubMedGoogle Scholar
  • 7 Yuzefpolskaya M, Schroeder SE, Houston BA. et al. The Society of Thoracic Surgeons INTERMACS 2022 annual report:Focus on the 2018 heart transplant allocation system. Ann Thorac Surg 2023; 115 (02) 311-327
    CrossrefPubMedGoogle Scholar
  • 8 Caraballo C, DeFilippis EM, Nakagawa S. et al. Clinical outcomes after left ventricular assist device implantation in older adults. An INTERMACS analysis. JACC Heart Fail 2019; 7 (12) 1069-1078
    CrossrefPubMedGoogle Scholar
  • 9 Sandner SE, Zimpfer D, Zrunek P. et al. Age and outcome after continuous-flow left ventricular assist device implantation as bridge to transplantation. J Heart Lung Transplant 2009; 28 (04) 367-372
    CrossrefPubMedGoogle Scholar
  • 10 Zhigalov K, Van den Eynde J, Chrosch T. et al. Outcomes of left ventricular assist device implantation for advanced heart failure in critically ill patients (INTERMACS 1 and 2): a retrospective study. Artif Organs 2021; 45 (07) 706-716
    CrossrefPubMedGoogle Scholar
  • 11 Merkle-Storms J, Djordjevic I, Sabashnikov A. et al. Comparative analysis of LVAD patients in regard of ischaemic or idiopathic cardiomyopathy: A propensity-score analysis of EUROMACS data. Int J Artif Organs 2022; 45 (03) 284-291
    CrossrefPubMedGoogle Scholar
  • 12 de By TMMH, Schoenrath F, Veen KM. et al. The European registry for patients with mechanical circulatory support of the European Association for Cardio-Thoracic Surgery: third report. Eur J Cardiothorac Surg 2022; 62 (01) ezac032
    CrossrefPubMedGoogle Scholar
  • 13 Kremer J, Meinert EFRC, Farag M. et al. New wound management of driveline infections with cold atmospheric plasma. J Cardiovasc Dev Dis 2022; 9 (11) 405
    PubMedGoogle Scholar
  • 14 Pya Y, Maly J, Bekbossynova M. et al. First human use of a wireless coplanar energy transfer coupled with a continuous-flow left ventricular assist device. J Heart Lung Transplant 2019; 38 (04) 339-343
    CrossrefPubMedGoogle Scholar
  • 15 Jennings DL, Weeks PA. Thrombosis in continuous-flow left ventricular assist devices: pathophysiology, prevention, and pharmacologic management. Pharmacotherapy 2015; 35 (01) 79-98
    CrossrefPubMedGoogle Scholar
  • 16 Gurbel PA, Shah P, Desai S, Tantry US. Antithrombotic strategies and device thrombosis. Cardiol Clin 2018; 36 (04) 541-550
    CrossrefPubMedGoogle Scholar
  • 17 Potapov EV, Nersesian G, Lewin D. et al. Propensity score-based analysis of long-term follow-up in patients supported with durable centrifugal left ventricular assist devices: the EUROMACS analysis. Eur J Cardiothorac Surg 2021; 60 (03) 579-587
    CrossrefPubMedGoogle Scholar
  • 18 Sidhu K, Lam PH, Mehra MR. Evolving trends in mechanical circulatory support: clinical development of a fully magnetically levitated durable ventricular assist device. Trends Cardiovasc Med 2020; 30 (04) 223-229
    CrossrefPubMedGoogle Scholar
  • 19 Mehra MR, Uriel N, Naka Y. et al; MOMENTUM 3 Investigators. A fully magnetically levitated left ventricular assist device: final report. N Engl J Med 2019; 380 (17) 1618-1627
    CrossrefPubMedGoogle Scholar
  • 20 Mehra MR, Goldstein DJ, Cleveland JC. et al. Five-year outcomes in patients with fully magnetically levitated vs axial-flow left ventricular assist devices in the MOMENTUM 3 randomized trial. JAMA 2022; 328 (12) 1233-1242
    CrossrefPubMedGoogle Scholar
  • 21 Maltais S, Anwer LA, Haglund NA. et al. Temporal differences in outcomes during long-term mechanical circulatory support. J Card Fail 2017; 23 (12) 852-858
    CrossrefPubMedGoogle Scholar
  • 22 Al-Naamani A, Fahr F, Khan A. et al. Minimally invasive ventricular assist device implantation. J Thorac Dis 2021; 13 (03) 2010-2017
    CrossrefPubMedGoogle Scholar
  • 23 Ricklefs M, Hanke JS, Dogan G. et al. Less invasive surgical approach for LVAD implantation. Semin Thoracic Surg 2018; 30 (01) 1-6
    PubMedGoogle Scholar
  • 24 Loyaga-Rendon RY, Kazui T, Acharya D. Antiplatelet and anticoagulation strategies for left ventricular assist devices. Ann Transl Med 2021; 9 (06) 521
    CrossrefPubMedGoogle Scholar
  • 25 Shoskes A, Fan TH, Starling RC, Cho S-M. Neurologic complications in patients with left ventricular assist devices. Can J Cardiol 2023; 39 (02) 210-221
    CrossrefPubMedGoogle Scholar
  • 26 Beavers CJ, Ambrosy AP, Butler J. et al. Iron deficiency in heart failure: a scientific statement from the heart failure society of America. J Card Fail 2023; 29 (07) 1059-1077
    CrossrefPubMedGoogle Scholar
  • 27 Busa V, Dardeir A, Marudhai S. et al. Role of vitamin D supplementation in heart failure patients with vitamin D deficiency and its effect on clinical outcomes: a literature review. Cureus 2020; 12 (10) e10840
    PubMedGoogle Scholar
  • 28 Ono M, Yamaguchi O, Ohtani T. et al. JCS/JSCVS/JATS/JSVS 2021 Guideline on implantable assist device for patients with advance heart failure. Circ J 2022; 86: 1024-1058
    CrossrefPubMedGoogle Scholar
  • 29 Uriel N, Burkhoff D, Rich JD. et al. Impact of hemodynamic ramp test-guided HVAD speed and medication adjustments on clinical outcome. The RAMP-IT-UP multicenter study. Circ Heart Fail 2019; 12: e006067
    CrossrefPubMedGoogle Scholar