Abstract 18793: Patients Awaiting Heart Transplantation on HeartWare Ventricular Assist Device Support for Greater than Two Years
Background: The use of left ventricular assist devices (VADs) as a bridge-to-transplant (BTT) for those with advanced heart failure is becoming more frequent. While there are potential risks and complications associated with VADs, the survival rate of patients placed on mechanical circulatory support is higher than in comparable patients managed with optimal medical therapies. Due to the increasing population affected by HF, further analysis of long term VAD performance is necessary.
Methods: Patients enrolled between August 2008 and November 2012 in the HeartWare® Bridge to Transplant (BTT) and Continued Access Protocol (CAP) trial who remained on support for more than 2 years were analyzed.
Results: Seventy four patients (19.4% (74/382) of the total patients in the BTT+CAP trial) remained on support for >2 years with a mean time on support of 967 days. Of these 74 patients, 47 (64%) were still on the wait list for a heart transplant. Of the 27 patients no longer listed, the most frequent reasons for delisting was BMI or weight contraindications (N=7) and patient decision/refusal (N=6). Compared to the patients on support for less than 2 years, the 74 patients were more frequently female, black/African American, had non-ischemic heart failure, and were INTERMACS profiles 3-7 at baseline. At six months and one year, patients on long-term support also had similar improvements in quality of life scores and improvements in distance walked in the 6 minute walk test. Post implant adverse event rates of bleeding, cardiac arrhythmias, infections, strokes, renal dysfunction and late right heart failure (see Table) were less frequent in patients on long term support. However, the rate of pump exchange for VAD thrombus was similar.
Conclusions: The HVAD successfully supported 74 of 382 patients for more than 2 years. Most of these patients are still listed and waiting for cardiac transplantation, and exhibit stable adverse event and quality of life profiles.
Author Disclosures: K.D. Aaronson: Research Grant; Modest; HeartWare Contract Research managed by University of Michigan. Consultant/Advisory Board; Modest; HeartWare (without remuneration). S. Silvestry: Consultant/Advisory Board; Modest; Heartware. Consultant/Advisory Board; Significant; Thoratec. S. Maltais: Consultant/Advisory Board; Modest; HeartWare. H.R. Mallidi: None. O. Frazier: Other; Modest; minimal travel reimbursement (HeartWare). S. Boyce: Ownership Interest; Modest; HeartWare. D.R. Hathaway: Employment; Significant; HeartWare. K.B. Najarian: Employment; Significant; HeartWare. M.S. Slaughter: Other Research Support; Modest; Training/Education grant HeartWare. F.D. Pagani: Research Grant; Modest; HeartWare Contract Research managed by University of Michigan.
- © 2014 by American Heart Association, Inc.