Single Center Long-Term Survival of 431 Consecutive Continuous Flow Fully Magnetically Levitated Left Ventricular Assist Device Implants
Presented During:
Monday, April 29, 2024: 2:15PM - 2:30PM
Metro Toronto Convention Center
Posted Room Name:
Room 717
Abstract No:
268
Submission Type:
Abstract Submission
Authors:
Aaron Weiss (1), Jean-Luc Maigrot (1), Michael Tong (1), Randall Starling (1), Nicholas Smedira (1), Shinya Unai (1), David Moros (1), Jerry Estep (2), Eugene Blackstone (1), Edward Soltesz (1)
Institutions:
(1) Cleveland Clinic, Cleveland, OH, (2) Cleveland Clinic Florida, Weston, FL
Submitting Author:
♦Aaron Weiss
-
Contact Me
Cleveland Clinic
Cleveland Clinic
Co-Author(s):
Jean-Luc Maigrot
-
Contact Me
Cleveland Clinic
Cleveland Clinic
*Michael Tong
-
Contact Me
Cleveland Clinic
Cleveland Clinic
Randall Starling
-
Contact Me
Cleveland Clinic
Cleveland Clinic
*Nicholas Smedira
-
Contact Me
Cleveland Clinic
Cleveland Clinic
*Shinya Unai
-
Contact Me
Cleveland Clinic
Cleveland Clinic
David Moros
-
Contact Me
Cleveland Clinic
Cleveland Clinic
Jerry Estep
-
Contact Me
Cleveland Clinic Florida
Cleveland Clinic Florida
*Eugene Blackstone
-
Contact Me
Cleveland Clinic
Cleveland Clinic
*Edward Soltesz
-
Contact Me
Cleveland Clinic
Cleveland Clinic
Presenting Author:
♦Aaron Weiss
-
Contact Me
Cleveland Clinic
Cleveland Clinic
Abstract:
Objective: Continuous flow fully magnetically levitated (CF-FML) left ventricular assist devices (LVAD) are a cornerstone of modern surgical treatment for end-stage heart failure. This study describes our high-volume single-center survival experience in a consecutive series of CF-FML LVAD implants.
Methods: From 10/2015-1/2023, 431 patients underwent CF-FML LVAD implant with 890 patient-years of follow-up available. Survival was estimated out to 5-years post-implant overall and stratified by Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) profile, ischemic (ICM) versus non-ischemic cardiomyopathy (NICM), and bridge to transplant (BTT) versus destination therapy (DT) strategies.
Results: Median age at implant was 61 years (15th,85th: 47.3, 71.7) and 109 (25%) patients were female. Preoperatively, at the time of CF-FML LVAD implant, 90 (21%) patients were supported with intra-aortic balloon pumps, 49 (11%) patients with temporary LVAD and 5 (1.2%) were on extracorporeal membrane oxygenation. Overall survival at 1- and 5-years post-implant was 88% and 58%. Intermacs profile was 1 in 19 (4.4%), 2 in 147 (34%), 3 in 125 (29%), and 4-7 in 145 (33%) patients. For Intermacs profile 1, 6-month survival was 66%. Survival at 1- and 5-years was 89% and 59% in profile 2, 94% and 68% in profile 3, and 84% and 59% in profiles 4-7, respectively. In NICM patients, survival at 1- and 5-years was 91% and 65%, and in ICM patients it was 84% and 53%. Survival did not differ in the early post-implant phase (≤3 weeks) between NICM and ICM patients (P=0.9) but was higher among NICM patients in the late post-implant phase beyond 3 weeks (P=0.006). For BTT patients, 1- and 5-year survival was 89% and 67% whereas DT survival was 87% and 55%, respectively.
Conclusion: This large single center experience demonstrates excellent long-term survival on CF-FML LVAD support. Survival was greatest among profile 3 patients potentially representing the benefit of timely intervention in advanced heart failure prior to deterioration. Survival was also increased among NICM compared to ICM patients and BTT compared to DT patients. Further studies to identify subpopulation-specific risk factors may allow for further improvement of outcomes.
Methods: From 10/2015-1/2023, 431 patients underwent CF-FML LVAD implant with 890 patient-years of follow-up available. Survival was estimated out to 5-years post-implant overall and stratified by Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) profile, ischemic (ICM) versus non-ischemic cardiomyopathy (NICM), and bridge to transplant (BTT) versus destination therapy (DT) strategies.
Results: Median age at implant was 61 years (15th,85th: 47.3, 71.7) and 109 (25%) patients were female. Preoperatively, at the time of CF-FML LVAD implant, 90 (21%) patients were supported with intra-aortic balloon pumps, 49 (11%) patients with temporary LVAD and 5 (1.2%) were on extracorporeal membrane oxygenation. Overall survival at 1- and 5-years post-implant was 88% and 58%. Intermacs profile was 1 in 19 (4.4%), 2 in 147 (34%), 3 in 125 (29%), and 4-7 in 145 (33%) patients. For Intermacs profile 1, 6-month survival was 66%. Survival at 1- and 5-years was 89% and 59% in profile 2, 94% and 68% in profile 3, and 84% and 59% in profiles 4-7, respectively. In NICM patients, survival at 1- and 5-years was 91% and 65%, and in ICM patients it was 84% and 53%. Survival did not differ in the early post-implant phase (≤3 weeks) between NICM and ICM patients (P=0.9) but was higher among NICM patients in the late post-implant phase beyond 3 weeks (P=0.006). For BTT patients, 1- and 5-year survival was 89% and 67% whereas DT survival was 87% and 55%, respectively.
Conclusion: This large single center experience demonstrates excellent long-term survival on CF-FML LVAD support. Survival was greatest among profile 3 patients potentially representing the benefit of timely intervention in advanced heart failure prior to deterioration. Survival was also increased among NICM compared to ICM patients and BTT compared to DT patients. Further studies to identify subpopulation-specific risk factors may allow for further improvement of outcomes.
ADULT CARDIAC:
Cardiac Transplant and Mechanical Circulatory Support
Image or Table
