(Circulation. 2001;103:231.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Mechanical Circulatory Support for Advanced Heart Failure
Effect of Patient Selection on Outcome
From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna, Austria; Cardiothoracic Surgery (B.R.), Hospital Großhadern, Munich, Germany; Cardiothoracic Surgery (A.P.), Hospital La Pitié Salpétrière, Paris, France; Cardiothoracic Surgery (T.M.), Hospital La Timone, Marseilles, France; Thoracic and Cardiovascular Surgery (D.Y.L.), Hospital Henri Mondor, Créteil, France; and Stanford University School of Medicine (P.M.P.), Stanford, Calif.
Correspondence to Mario C. Deng, MD, FESC, FACC, Director of Cardiac Transplantation Research, The Heart Failure Center & Division of Circulatory Physiology, Columbia University College of Physicians & Surgeons, New York Presbyterian Hospital, Milstein Hospital Building, Room 5-435, 177 Fort Washington Ave, New York, NY 10032. E-mail md785{at}columbia.edu
Background—Use of wearable left ventricular assist systems (LVAS) in the treatment of advanced heart failure has steadily increased since 1993, when these devices became generally available in Europe. The aim of this study was to identify in an unselected cohort of LVAS recipients those aspects of patient selection that have an impact on postimplant survival.
Methods and Results—Data were obtained from the Novacor European Registry. Between 1993 and 1999, 464 patients were implanted with the Novacor LVAS. The majority had idiopathic (60%) or ischemic (27%) cardiomyopathy; the median age at implant was 49 (16 to 75) years. The median support time was 100 days (4.1 years maximum). Forty-nine percent of the recipients were discharged from the hospital on LVAS; they spent 75% of their time out of the hospital. For a subset of 366 recipients, for whom a complete set of data was available, multivariate analysis revealed that the following preimplant conditions were independent risk factors for survival after LVAS implantation: respiratory failure associated with septicemia (odds ratio 11.2), right heart failure (odds ratio 3.2), age >65 years (odds ratio 3.01), acute postcardiotomy (odds ratio 1.8), and acute infarction (odds ratio 1.7). For patients without any of these factors, the 1-year survival after LVAS implantation including the posttransplantation period was 60%; for the combined group with at least 1 risk factor, it was 24%.
Conclusions—Careful selection, specifically implantation before patients become moribund, and improvement of management may result in improved outcomes of LVAS treatment for advanced heart failure.
Key Words: heart-assist device • heart failure • patients
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|
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