5-year results of a newly implemented mechanical circulatory support program for terminal heart failure patients in a Swiss non-cardiac transplant university hospital

Autor: Urs Zenklusen, Stefan Osswald, Brigitta Gahl, Nadine Cueni, Otmar Pfister, Simon Scheifele, Thibault Schaeffer, Florian Rueter, Paul Mohacsi, Martin Siegemund, Jens Fassl, Hans Pargger, Constantin Mork, Thomas Doebele, Martin Grapow, Joachim Erb, Anne Morgen, Markus Maurer, Friedrich Eckstein
Rok vydání: 2020
Předmět:
Pulmonary and Respiratory Medicine
Male
medicine.medical_specialty
medicine.medical_treatment
lcsh:Surgery
Destination therapy
Left ventricular assist device
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
lcsh:RD78.3-87.3
Hospitals
University

03 medical and health sciences
0302 clinical medicine
medicine
Humans
030212 general & internal medicine
Comprehensive heart-failure center
Stroke
Contraindication
Aged
Retrospective Studies
Heart Failure
business.industry
General Medicine
lcsh:RD1-811
Middle Aged
medicine.disease
Cardiac surgery
Prosthesis Failure
Transplantation
Cardiothoracic surgery
lcsh:Anesthesiology
Ventricular assist device
Heart failure
Emergency medicine
Heart Transplantation
Surgery
Female
Heart-Assist Devices
Cardiology and Cardiovascular Medicine
business
Switzerland
Follow-Up Studies
Research Article
Zdroj: Journal of Cardiothoracic Surgery
Journal of Cardiothoracic Surgery, Vol 16, Iss 1, Pp 1-10 (2021)
ISSN: 1749-8090
Popis: Background In Switzerland, long-term circulatory support programs have been limited to heart transplant centers. In 2014, to improve the management of patients with end-stage heart failure not eligible for transplantation, we implemented a left ventricular assist device (LVAD) program for destination therapy at the University Hospital of Basel. Methods We described the program set-up with practical aspects. Patients aged 65 and above with therapy refractory end-stage heart failure without major contraindication for LVAD implantation were included. Younger patients with bridge-to-candidacy profile were also considered. Using the Kaplan-Meier estimate, we retrospectively analyzed the overall survival and freedom from major adverse events after LVAD implantation. We compared our results to internationally reported data. Results Between October 2014 and September 2019, 16 patients received an LVAD in our center. The mean age at implantation was 67.1 years. The mean EuroSCORE II was 24.4% and the median INTERMACS level was 4. Thirteen patients received an LVAD as destination therapy and three patients as bridge-to-candidacy. The overall survival was 87.5 and 70% at 1 and 2 years, respectively. Freedom from stroke was 81.3% at 1 and 2 years. Freedom from device infection was 67.7 and 58.7% at 1 and 2 years, respectively. Freedom from gastrointestinal bleeding was 75 and 56.3% at 1 and 2 years, respectively. Freedom from readmission was 50 and 31.3% and at 6 months and 1 year, respectively. Conclusions The Basel experience demonstrated the possible implementation of an LVAD program for destination therapy or bridge-to-candidacy in a non-transplant comprehensive heart-failure center with midterm survival results and freedom from major adverse events comparable to international registries. Patient selection remains crucial. Trial registration This study was registered on the ClinicalTrials.gov database (NCT04263012).
Databáze: OpenAIRE