Featured articleClinical outcomes for continuous-flow left ventricular assist device patients stratified by pre-operative INTERMACS classification
Section snippets
Study population
Our study cohort consisted of consecutive patients implanted before August 27, 2007 at the University of Minnesota, University of Pittsburgh and Columbia University with either a VentrAssist or a HeartMate II LVAD, regardless of the original indication for implantation (BTT or DT). Each patient was categorized according to their INTERMACS classification at the time of implant by agreement between the surgeon and cardiologist at the center implanting the LVAD (Table 1), and then 3 groups were
Results
This analysis included 101 consecutive end-stage heart failure patients implanted with either a VentrAssist or a HeartMate II as BTT or DT before August 27, 2007. There were 51 patients enrolled at the University of Minnesota, 27 patients enrolled at Columbia University and 23 patients enrolled at the University of Pittsburgh. Baseline characteristics of the enrolled patients are shown in Table 2. Most of the patients enrolled were implanted as BTT. There were 28 patients in Group 1 (27.2%), 49
Discussion
Outcomes with mechanical circulatory support have gradually improved over time as a result of improvements in device technology and experience gained in intra- and peri-operative patient management. Over the past decade, there has been growing evidence regarding the importance of patient selection on outcomes with mechanical circulatory support. The pre-operative risk stratification system used in this study differs from previous models in two important ways. First, although previous
Limitations
There are several limitations to the present analysis. First, our results should be interpreted in the context of retrospective data collected across multiple sites. The overall size of the cohort was relatively small and the patients were not evenly distributed across groups, with Group 2 being nearly twice the size of the other groups. Patients were not randomized in the analysis as their groupings were based on their pre-operative classification and all patients received either a HeartMate
Disclosure statement
R.J. received a research grant from Thoratec Corporation. A.B., Y.N. and J.T. are consultants to Thoratec. The remaining authors have no conflicts of interests to disclose.
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