Clinical outcome in patients with end-stage heart failure who underwent continuous-flow left ventricular assist devices in a single center
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Background/Aims: The continuous flow left ventricular assist device (cf-LVAD) has improved the survival of chronic endstage heart failure (HF) patients. Here we describe our clinical experience of the initial 50 LVAD patients from a single center. Methods: A total of 50 patients underwent LVAD implantation as bridge to transplantation (BTT; n = 28, 56%), bridge to candidacy (BTC; n = 2, 4%), or as destination therapy (DT; n = 20, 40%) from 2012 to 2019. Pre-implant characteristics and clinical outcomes were compared between BTT/BTC and DT. Results: The median age of patients was 67 years (range, 59 to 73). Men were more likely to receive LVAD (76% vs. 24%) than women. DT patients were older, had smaller body surface area, and worse laboratory profiles than BTT/BTC patients. There was no in-hospital mortality. During an average of 14 months (range, 8 to 23), the all-cause mortality was 22%. The first-year survival was 86 and 90% in BTT/BTC and DT groups, respectively. Hemorrhagic stroke was the most common cause (27%) of death. In the BTT/BTC group, 22 patients successfully underwent heart transplantation during median duration of 10 months (range, 7 to 14). The most common post-LVAD complication during the first year of LVAD implantation was major bleeding (44%). A significant proportion (76%) of patients experienced rehospitalization with gastrointestinal bleeding as the most common cause. Conclusions: We describe short-term clinical outcome of LVAD patients from a single center for the first time in Korea. With the newer generation LVAD and a dedicated team approach, improved clinical outcomes of LVAD for end-stage HF are expected.
Abstract
Background/Aims: The continuous flow left ventricular assist device (cf-LVAD) has improved the survival of chronic endstage heart failure (HF) patients. Here we describe our clinical experience of the initial 50 LVAD patients from a single center. Methods: A total of 50 patients underwent LVAD implantation as bridge to transplantation (BTT; n = 28, 56%), bridge to candidacy (BTC; n = 2, 4%), or as destination therapy (DT; n = 20, 40%) from 2012 to 2019. Pre-implant characteristics and clinical outcomes were compared between BTT/BTC and DT. Results: The median age of patients was 67 years (range, 59 to 73). Men were more likely to receive LVAD (76% vs. 24%) than women. DT patients were older, had smaller body surface area, and worse laboratory profiles than BTT/BTC patients. There was no in-hospital mortality. During an average of 14 months (range, 8 to 23), the all-cause mortality was 22%. The first-year survival was 86 and 90% in BTT/BTC and DT groups, respectively. Hemorrhagic stroke was the most common cause (27%) of death. In the BTT/BTC group, 22 patients successfully underwent heart transplantation during median duration of 10 months (range, 7 to 14). The most common post-LVAD complication during the first year of LVAD implantation was major bleeding (44%). A significant proportion (76%) of patients experienced rehospitalization with gastrointestinal bleeding as the most common cause. Conclusions: We describe short-term clinical outcome of LVAD patients from a single center for the first time in Korea. With the newer generation LVAD and a dedicated team approach, improved clinical outcomes of LVAD for end-stage HF are expected.
참고문헌 (37)
- Jung Hoon Lee, "Epidemiology of Heart Failure in Korea: Present and Future", Korean Circulation Journal, 46(5), pp.658~664 (2016), 대한심장학회
- Kim KJ, "Focused update of 2016 Korean Society of Heart Failure guidelines for the management of chronic heart failure", Int J Heart Fail, 1, pp.4~24 (2019)
- Jin Joo Park, "Current status of heart failure: global and Korea", The Korean Journal of Internal Medicine, 35(3), pp.487~497 (2020), 대한내과학회[DOI]
- Darae Kim, "The Korean Organ Transplant Registry (KOTRY): Second Official Adult Heart Transplant Report", Korean Circulation Journal, 49(8), pp.724~737 (2019), 대한심장학회[DOI]
- Kim IC, "Donor heart utilization in Korea", Int J Heart Fail, 2, pp.254~263 (2020)
- Annual Report of the Transplant 2019, "Korean Network for Organ Sharing", KONOS, ~ (2019)
- Howard J. Eisen, "Left Ventricular Assist Devices (LVADS): History, Clinical Application and Complications", Korean Circulation Journal, 49(7), pp.568~585 (2019), 대한심장학회[DOI]
- Aaronson KD, "Left ventricular assist device therapy improves utilization of donor hearts", J Am Coll Cardiol, 39, pp.1247~1254 (2002)
- McCarthy PM, "Implantable left ventricular assist device. Approaching an alternative for endstage heart failure. Implantable LVAD Study Group", Circulation, 90, pp.II83~II86 (1994)
- Estep JD, "Risk ssessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients : results from the ROADMAP study", J Am Coll Cardiol, 66, pp.1747~1761 (2015)
- 최홍미, "Update on heart failure management and future directions", The Korean Journal of Internal Medicine, 34(1), pp.11~43 (2019), 대한내과학회[DOI]
- Lee S, "Successful mechanical circulatory support as a bridge to transplantation", Asian Cardiovasc Thorac Ann, 15, pp.243~245 (2007)
- 이가연, "The Successful Implantation of Continuous-Flow Left Ventricular Assist Device as a Destination Therapy in Korea: Echocardiographic Assessment", Journal of Korean Medical Science, 29(1), pp.137~140 (2014), 대한의학회
- Rose EA, "Long-term use of a left ventricular assist device for end-stage heart failure", N Engl J Med, 345, pp.1435~1443 (2001)
- Miller LW, "Use of a continuous-flow device in patients awaiting heart transplantation", N Engl J Med, 357, pp.885~896 (2007)
- Aaronson KD, "Use of an intrapericardial, continuous-flow, centrifugal pump in patients awaiting heart transplantation", Circulation, 125, pp.3191~3200 (2012)
- Heatley G, "Clinical trial design and rationale of the Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3(MOMENTUM 3)investigational device exemption clinical study protocol", J Heart Lung Transplant, 35, pp.528~536 (2016)
- Mehra MR, "A fully magnetically levitated circulatory pump for advanced heart failure", N Engl J Med, 376, pp.440~450 (2017)
- Slaughter MS, "Advanced heart failure treated with continuous-flow left ventricular assist device", N Engl J Med, 361, pp.2241~2251 (2009)
- Najjar SS, "An analysis of pump thrombus events in patients in the HeartWare ADVANCE bridge to transplant and continued access protocol trial", J Heart Lung Transplant, 33, pp.23~34 (2014)
- Kirklin JK, "Interagency Registry for Mechanically Assisted Circulatory Support(INTERMACS)analysis of pump thrombosis in the HeartMate II left ventricular assist device", J Heart Lung Transplant, 33, pp.12~22 (2014)
- Felker GM, "A standardized definition of ischemic cardiomyopathy for use in clinical research", J Am Coll Cardiol, 39, pp.210~218 (2002)
- Levey AS, "Definition and classification of chronic kidney disease : a position statement from Kidney Disease : Improving Global Outcomes(KDIGO)", Kidney Int, 67, pp.2089~2100 (2005)
- Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease 2017 Report, "Global Initiative for Chronic Obstructive Lung Disease", GOLD, ~ (2017)
- Sacco RL, "An updated definition of stroke for the 21st century : a statement for healthcare professionals from the American Heart Association", American Stroke Association, 2013, pp.44, 2064~2089
- Hannan MM, "Working formulation for the standardization of definitions of infections in patients using ventricular assist devices", J Heart Lung Transplant, 30, pp.375~384 (2011)
- Goldstein DJ, "Third annual report from the ISHLT mechanically assisted circulatory support registry : a comparison of centrifugal and axial continuous-flow left ventricular assist devices", J Heart Lung Transplant, 38, pp.352~363 (2019)
- Teuteberg JJ, "The Society of Thoracic Surgeons intermacs 2019 annual report : the changing landscape of devices and indications", Ann Thorac Surg, 109, pp.649~660 (2020)
- Agrawal S, "Thirty-day readmissions after left ventricular assist device implantation in the United States : insights from the nationwide readmissions database", Circ Heart Fail, 11, pp.e004628~ (2018)
- Jorde UP, "Results of the destination therapy post-food and drug administration approval study with a continuous flow left ventricular assist device : a prospective study using the INTERMACS registry(Interagency Registry for Mechanically Assisted Circulatory Support)", J Am Coll Cardiol, 63, pp.1751~1757 (2014)
- Starling RC, "Unexpected abrupt increase in left ventricular assist device thrombosis", N Engl J Med, 370, pp.33~40 (2014)
- Uriel N, "Hemocompatibility-related outcomes in the MOMENTUM 3 trial at 6 months : a randomized controlled study of a fully magnetically levitated pump in advanced heart failure", Circulation, 135, pp.2003~2012 (2017)
- Mehra MR, "A fully magnetically levitated left ventricular assist device : final report", N Engl J Med, 380, pp.1618~1627 (2019)
- Cowger J, "Comprehensive review and suggested strategies for the detection and management of aortic insufficiency in patients with a continuous-flow left ventricular assist device", J Heart Lung Transplant, 34, pp.149~157 (2015)
- Pagani FD, "Extended mechanical circulatory support with a continuous-flow rotary left ventricular assist device", J Am Coll Cardiol, 54, pp.312~321 (2009)
- Hernandez RE, "Present-day hospital readmissions after left ventricular assist device implantation : a large single-center study", Tex Heart Inst J, 42, pp.419~429 (2015)
- Hasin T, "Readmissions after implantation of axial flow left ventricular assist device", J Am Coll Cardiol, 61, pp.153~163 (2013)