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This is the first study investigating the long-term outcome of mechanical circulatory support (MCS) in The Netherlands.
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The 1‑, 3‑ and 5‑year survival on MCS was 83%, 72% and 57%, respectively. These results support its use as an extended bridge to heart transplantation, as necessitated by the shortage of donor hearts in our country.
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Survival in the period 2006–2012 did not differ from that in 2013–2017.
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Adverse events in terms of major bleeding and stroke occurred 0.51 and 0.15 times per patient year, respectively.
Background
Methods
Study population
cf-LVAD implantation and anticoagulation
Outcome
Definition of adverse events
Statistical analysis
Results
Baseline
Total | HM-II | HVAD | HM 3 | |
---|---|---|---|---|
n (%) | n (%) | n (%) | n (%) | |
Total | 268 (100) | 159 (59) | 71 (27) | 38 (14) |
Age (years, mean ± SD) | 50 ± 13 | 48 ± 13 | 54 ± 12 | 51 ± 14 |
Gender—male | 185 (69) | 109 (69) | 52 (73) | 24 (63) |
Aetiology of cardiomyopathy | ||||
Dilated | 146 (54.5) | 97 (61) | 27 (38) | 22 (57.9) |
Hypertrophic | 5 (1.9) | 4 (2.5) | 1 (1.4) | 0 (0) |
Ischaemic | 69 (25.7) | 35 (22) | 27 (38) | 7 (18.4) |
Myocarditis | 11 (4.1) | 9 (5.7) | 2 (2.8) | 0 (0) |
Peri-partum | 3 (1.1) | 2 (1.3) | 1 (1.4) | 0 (0) |
Toxic | 7 (2.6) | 6 (3.8) | 0 (0) | 1 (2.6) |
Congenital | 1 (0.4) | 1 (0.6) | 0 (0) | 0 (0) |
Other | 26 (9.7) | 5 (3.1) | 13 (18.3) | 8 (21.1) |
INTERMACS profile | ||||
1 Critical cardiogenic shock without MCS | 10 (3.7) | 6 (3.8) | 3 (4.2) | 1 (2.6) |
1* Critical cardiogenic shock with MCS | 52 (19.4) | 24 (15.1) | 23 (32.4) | 5 (13.2) |
2 Progressive decline on inotropic support | 112 (41.8) | 75 (47.2) | 20 (28.2) | 17 (44.7) |
3 Stable but inotrope dependent | 71 (26.5) | 43 (27) | 18 (25.4) | 10 (26.3) |
4 Resting symptoms at home on oral therapy | 22 (8.2) | 10 (6.3) | 7 (9.9) | 5 (13.2) |
6 Exertion limited | 1 (0.4) | 1 (0.6) | 0 (0) | 0 (0) |
Primary outcome
Cause of death | Number of patients (%) | ≤30 days postoperative | >30 days postoperative |
---|---|---|---|
Multi-organ failure | 4 (5.6%) | 2 (9.5%) | 2 (4%) |
RV failure | 7 (9.9%) | 1 (4.8%) | 6 (12%) |
Device malfunction | 7 (9.9%) | 0 (0%) | 7 (14%) |
Neurological | 22 (31%) | 4 (19%) | 18 (36%) |
Infection | 14 (19.7%) | 5 (23.8%) | 9 (18%) |
Other | 17 (23.9%) | 9 (42.9%) | 8 (16%) |
Total mortality | 71 (100%) | 21 (29.6%) | 50 (70.4%) |
Secondary outcomes
Clinical data | Complications | ||||
---|---|---|---|---|---|
Events | Event rate | ||||
Patient years—total | 510 | Cardiac arrhythmia—SVT | 129 | 0.25 | |
Patient years—HM-II | 380 | Cardiac arrhythmia—VT | 180 | 0.35 | |
Patient years—HVAD | 99 | Device malfunction—major | 50 | 0.1 | |
Patient years—HM 3 | 30 | Device malfunction—minor | 83 | 0.16 | |
30-day mortality (%) | 7.8 | Haemolysis—major | 76 | 0.15 | |
90-day mortality (%) | 11.2 | Haemolysis—minor | 131 | 0.26 | |
Hospitalisation (days, mean ± SD) | 50 ± 36 | Hepatic dysfunction | 68 | 0.13 | |
Postoperative data | Hypertension | 8 | 0.02 | ||
ICU stay (days, mean ± SD) | 11 ± 12 | Major bleeding—ENT | 15 | 0.03 | |
Ventilator (days, mean ± SD) | 5.5 ± 9.7 | Major bleeding—GI | 72 | 0.14 | |
Inotropics (days, mean ± SD) | 5.8 ± 7.2 | Major bleeding—other | 174 | 0.34 | |
Major infection—exit site | 82 | 0.16 | |||
Major infection—pocket | 15 | 0.03 | |||
Major infection—sepsis | 103 | 0.2 | |||
Haemorrhagic stroke | 25 | 0.05 | |||
Ischaemic stroke | 51 | 0.1 | |||
Neurological dysfunction—TIA | 30 | 0.06 | |||
Pericardial fluid effusion | 41 | 0.08 | |||
Renal dysfunction—acute | 50 | 0.1 | |||
Renal dysfunction—chronic | 4 | 0.01 | |||
Respiratory failure | 76 | 0.15 | |||
Right heart failure | 116 | 0.23 |