Objectives: Continuous-flow LVAD has been widely used for bridging a patient to heart transplantation. There are many researches which focus on the survival, adverse events and quality of life in these patients separately during LVAD support and after heart transplantation. We sought to examine the survival and outcomes in these patients beginning from LVAD implantation through post-heart transplantation as the first step to evaluate cf-LVAD lifetime management.
Methods: 228 patients were implanted with cf-LVAD for BTT between 2007 and 2023. Follow-up evaluation was closed in February 2024. There were 164 male patients (72%) with a mean age of 41.1 years (11 – 67). Average body size was 166.8 cm in height, 56.3 kg in weight and 1.62 m2 in body surface area. Majority of etiology for advanced heart failure was idiopathic DCM in 142 (62%), followed by dilated-phase of hypertrophic cardiomyopathy in 18 (8%), ischemic heart disease in 17 (7%) and miscellaneous. INTERMACS profiles at implant was 1 in 5 (2%), 2 in 80 (35%), 3 in 131 (57%) and 4 in 12 (5%). Various types of devices were used such as HeartMate II in 72, EVAHEART in 46, Jarvik 2000 in 38, HeartMate 3 in 30, HVAD in 22 and DuraHeart in 20. Follow-up rate was 100% complete.
Results: Mean LVAD support duration was 1250 days. Survival after LVAD implantation was 94.2 %, 91.7%, 88.3% and 84.1% at 1, 2, 3, and 4 years (censored at transplantation and weaning device removal). Finally, 112 patients underwent transplantation, 14 patients were weaned from the LVAD and 66 patients were under on-going support with a mean follow-up duration of 6.2 years after LVAD. The survival combining LVAD implantation and transplantation or weaning from the device was 94.0%, 87.0%, 82.2% and 76.6% at 1, 3, 5 and 10 years after LVAD implantation.
Conclusions: Lifetime management of the advanced heart failure patients who were implanted with cf-LVAD as BTT designation was successful and satisfactory in this study. Next study should be undertaken to show the quality of life and freedom from adverse events during the waiting period and after they reached a goal (transplantation or weaning from the device).