Abstract 3658: Application of the Seattle Heart Failure Model to the HeartWare 3rd Generation LVAD
Background The HeartWare LVAD (HVAD) is a third generation minaturized LVAD that has been implanted in >50 patients. Identification of patients for destination and bridge to transplant LVADs is important as we move into lower risk ambulatory heart failure patients. The Seattle Heart Failure Model (SHFM) is a widely validated multivariate risk model.
Methods We compared the predicted medical survival using the SHFM as previously described (JHLT 2009) in 47 patients.
Results All patients were on inotropic therapy and 11% were on an IABP. Average support was 312 days. At 1 year there were 6 deaths, 1 explant for recovery, and 11 transplants. The SHFM estimate of survival with medical therapy at 30 days and 1 year was 93±1% and 57±4% (mean±standard error of the estimate). The Kaplan Meier survival at 30 days (96±3%) and 1 year (86±6%) were excellent. The 30-day HVAD survival (96±3%) and the SHFM estimated survival (93%±1%) with medical therapy were similar at 30 days. Beyond 30 days, the HVAD survival was superior to medical therapy. At 1 year, the estimated hazard ratio for benefit from the HVAD was 0.28 (95% CI 0.15– 0.42, p<0.0001). There was no evidence that the HVAD hazard ratio varied in patients with predicted survival above or below the median SHFM estimate (Hazard ratio above median 0.19 vs. 0.27 below median, both p<0.001).
Conclusions Treatment of high risk patients with the HVAD, a 3rd generation LAVD provided superb outcomes at 1 year and was superior to medical therapy as estimated by the Seattle Heart Failure Model was an estimated mortality reduction of 72%. The one year survival with the HVAD (86%) is similar to the 1 year survival with cardiac transplantation for UNOS status 1 patients (87%).