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Continuous-flow LVADs in the Nordic countries : complications and mortality and its predictors

Braun, Oscar Ö. LU ; Nilsson, Johan LU ; Gustafsson, Finn; Dellgren, Göran; Fiane, Arnt E.; Lemström, Karl; Hubbert, Laila; Hellgren, Laila and Lund, Lars H. (2019) In Scandinavian Cardiovascular Journal
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.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Heart failure, left ventricular assist device, mechanical circulatory support, outcomes
in
Scandinavian Cardiovascular Journal
publisher
Taylor & Francis
external identifiers
  • 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
2019-04-10 04:21:15
@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 &gt;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 &lt;.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},
  keyword      = {Heart failure,left ventricular assist device,mechanical circulatory support,outcomes},
  language     = {eng},
  month        = {03},
  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},
  year         = {2019},
}