Continuous-flow LVADs in the Nordic countries : complications and mortality and its predictors
(2019) In Scandinavian Cardiovascular Journal 53(1). p.14-20- Abstract
Objectives: The purpose of this study was to assess complications and mortality and its predictors, with continuous-flow left ventricular assist devices (CF-LVADs) in the Nordic Countries. Design: This was a retrospective, international, multicenter cohort study. Results: Between 1993 and 2013, 442 surgically implanted long-term mechanical assist devices were used among 8 centers in the Nordic countries. Of those, 238 were CF-LVADs (HVAD or HeartMate II) implanted in patients >18 years with complete data. Postoperative complications and survival were compared and Cox proportion hazard regression analysis was used to identify predictors of mortality. The overall Kaplan–Meier survival rate was 75% at 1 year, 69% at 2 years and 63% at 3... (More)
Objectives: The purpose of this study was to assess complications and mortality and its predictors, with continuous-flow left ventricular assist devices (CF-LVADs) in the Nordic Countries. Design: This was a retrospective, international, multicenter cohort study. Results: Between 1993 and 2013, 442 surgically implanted long-term mechanical assist devices were used among 8 centers in the Nordic countries. Of those, 238 were CF-LVADs (HVAD or HeartMate II) implanted in patients >18 years with complete data. Postoperative complications and survival were compared and Cox proportion hazard regression analysis was used to identify predictors of mortality. The overall Kaplan–Meier survival rate was 75% at 1 year, 69% at 2 years and 63% at 3 years. A planned strategy of destination therapy had poorer survival compared to a strategy of bridge to transplantation or decision (2-year survival of 41% vs. 76%, p <.001). The most common complications were non-driveline infections (excluding sepsis) (44%), driveline infection (27%), need for continuous renal replacement therapy (25%) and right heart failure (24%). In a multivariate model age and left ventricular diastolic dimension was left as independent risk factors for mortality with a hazard ratio of 1.35 (95% confidence interval (CI) [1.01–1.80], p =.046) per 10 years and 0.88 (95% CI [0.72–0.99], p =.044) per 5 mm, respectively. Conclusion: Outcome with CF LVAD in the Nordic countries was comparable to other cohorts. Higher age and destination therapy require particularly stringent selection.
(Less)
- author
- Braun, Oscar Ö. LU ; Nilsson, Johan LU ; Gustafsson, Finn ; Dellgren, Göran ; Fiane, Arnt E. ; Lemström, Karl ; Hubbert, Laila ; Hellgren, Laila and Lund, Lars H.
- organization
- publishing date
- 2019-03-05
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Heart failure, left ventricular assist device, mechanical circulatory support, outcomes
- in
- Scandinavian Cardiovascular Journal
- volume
- 53
- issue
- 1
- pages
- 14 - 20
- publisher
- Taylor & Francis
- external identifiers
-
- pmid:30776923
- scopus:85062496106
- ISSN
- 1401-7431
- DOI
- 10.1080/14017431.2019.1583365
- language
- English
- LU publication?
- yes
- id
- 320e6f13-5388-44f9-9389-1de16d7ad16d
- date added to LUP
- 2019-03-18 14:42:06
- date last changed
- 2024-08-20 12:18:46
@article{320e6f13-5388-44f9-9389-1de16d7ad16d, abstract = {{<p>Objectives: The purpose of this study was to assess complications and mortality and its predictors, with continuous-flow left ventricular assist devices (CF-LVADs) in the Nordic Countries. Design: This was a retrospective, international, multicenter cohort study. Results: Between 1993 and 2013, 442 surgically implanted long-term mechanical assist devices were used among 8 centers in the Nordic countries. Of those, 238 were CF-LVADs (HVAD or HeartMate II) implanted in patients >18 years with complete data. Postoperative complications and survival were compared and Cox proportion hazard regression analysis was used to identify predictors of mortality. The overall Kaplan–Meier survival rate was 75% at 1 year, 69% at 2 years and 63% at 3 years. A planned strategy of destination therapy had poorer survival compared to a strategy of bridge to transplantation or decision (2-year survival of 41% vs. 76%, p <.001). The most common complications were non-driveline infections (excluding sepsis) (44%), driveline infection (27%), need for continuous renal replacement therapy (25%) and right heart failure (24%). In a multivariate model age and left ventricular diastolic dimension was left as independent risk factors for mortality with a hazard ratio of 1.35 (95% confidence interval (CI) [1.01–1.80], p =.046) per 10 years and 0.88 (95% CI [0.72–0.99], p =.044) per 5 mm, respectively. Conclusion: Outcome with CF LVAD in the Nordic countries was comparable to other cohorts. Higher age and destination therapy require particularly stringent selection.</p>}}, author = {{Braun, Oscar Ö. and Nilsson, Johan and Gustafsson, Finn and Dellgren, Göran and Fiane, Arnt E. and Lemström, Karl and Hubbert, Laila and Hellgren, Laila and Lund, Lars H.}}, issn = {{1401-7431}}, keywords = {{Heart failure; left ventricular assist device; mechanical circulatory support; outcomes}}, language = {{eng}}, month = {{03}}, number = {{1}}, pages = {{14--20}}, publisher = {{Taylor & Francis}}, series = {{Scandinavian Cardiovascular Journal}}, title = {{Continuous-flow LVADs in the Nordic countries : complications and mortality and its predictors}}, url = {{http://dx.doi.org/10.1080/14017431.2019.1583365}}, doi = {{10.1080/14017431.2019.1583365}}, volume = {{53}}, year = {{2019}}, }