Mechanical circulatory support with a continuous-flow left ventricular assist device (LVAD) is despite heart transplantation (HTx) and pharmacological therapy a valuable treatment option in end-stage heart failure. (
In this study we report results and outcomes of patients enrolled in the LVAD program established by the Department of Cardiac and Transplant Surgery and the Division of Cardiology of University Hospital Dubrava.
We retrospectively examined the outcomes from 18 LVAD recipients between October 2011 and October 2016. The mean recipient age was 56.6±13.0 years, and 61% were male. Dilated cardiomyopathy was present in 56% and ischemic in 44%. Two patients (11%) were INTERMACS 1 and other two INTERMACS 2, 6 (33%) were INTERMACS 3 and 8 patients (44%) were stage 4. Device implanted the most was HeartMate II in 11 patients (61%), followed by HeartWare in 5 cases (27%) and most recently HeartMate III in 3 patients (17%). Of our patients 50% were destination therapy (DT), 17% are considered to be bridge to decision, 11% are bridge to candidacy, while 4 patients were bridge to transplant (BTT). All patients in DT group were ineligible for HTx, except one who declined HTx. Of the BTT patients 2 finally underwent HTx. Overall survival at 30 days, 6 months and 1 year on LVAD was 88%, respectively. Both deaths occurred during postoperative care within one month after implantation due to severe right ventricular failure. During follow-up, NYHA functional class improved from 3.8 ± 0.3 to 2.1 ± 0.5 at 12 months.
Continuous-flow LVAD therapy is a viable treatment option for patients with end-stage heart failure ineligible for HTx or as a bridging strategy, with good survival and functional class improvement. An essential prerequisite for a successful LVAD program is careful selection and meticulous preparation of patients, as well as tight controls during follow up, and an excellent cooperation of cardiac surgeons, heart failure cardiologists and perfusionists.