Background

Preoperative variables can predict short term left ventricular assist device (LVAD) survival, but predictors of extended survival remain insufficiently characterized.

Method

Patients undergoing LVAD implant (2012-2018) in the Intermacs registry were grouped according to time on support: short-term (<1 year, n = 7,483), mid-term (MT, 1-3 years, n = 5,976) and long-term (LT, ≥3 years, n = 3,015). Landmarked hazard analyses (adjusted hazard ratio, HR) were performed to identify correlates of survival after 1 and 3 years of support.

Results

After surviving 1 year of support, additional LVAD survival was less likely in older (HR 1.15 per decade), Caucasian (HR 1.22) and unmarried (HR 1.16) patients (p < 0.05). After 3 years of support, only 3 preoperative characteristics (age, race, and history of bypass surgery, p < 0.05) correlated with extended survival. Postoperative events most negatively influenced achieving LT survival. In those alive at 1 year or 3 years, the occurrence of postoperative renal (creatinine HR MT = 1.09; LT HR = 1.10 per mg/dl) and hepatic dysfunction (AST HR MT = 1.29; LT HR = 1.34 per 100 IU), stroke (MT HR = 1.24; LT HR = 1.42), infection (MT HR = 1.13; LT HR = 1.10), and/or device malfunction (MT HR = 1.22; LT HR = 1.46) reduced extended survival (all p ≤ 0.03).

Conclusions

Success with LVAD therapy hinges on achieving long term survival in more recipients. After 1 year, extended survival is heavily constrained by the occurrence of adverse events and postoperative end-organ dysfunction. The growth of destination therapy intent mandates that future LVAD studies be designed with follow up sufficient for capturing outcomes beyond 24 months.

中文翻译：

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LVAD 支持的长期生存：设备并发症和终末器官功能障碍限制了长期成功

背景

术前变量可以预测短期左心室辅助装置 (LVAD) 存活率，但延长存活率的预测因子仍未充分表征。

方法

在 Intermacs 登记处接受 LVAD 植入的患者（2012-2018 年）根据支持时间分组：短期（<1 年，n  = 7,483）、中期（MT，1-3 年，n  = 5,976）和长期（LT，≥3 年，n  = 3,015）。进行了具有里程碑意义的风险分析（调整后的风险比，HR），以确定支持后 1 年和 3 年的生存相关性。

结果

在支持 1 年后，老年（每十年 HR 1.15）、高加索人（HR 1.22）和未婚（HR 1.16）患者的额外 LVAD 存活率降低（p < 0.05）。经过 3 年的支持，只有 3 个术前特征（年龄、种族和搭桥手术史，p < 0.05）与延长生存期相关。术后事件对实现 LT 生存的负面影响最大。在存活 1 年或 3 年的患者中，术后肾功能（肌酐 HR MT = 1.09；LT HR = 1.10 / mg/dl）和肝功能障碍（AST HR MT = 1.29；LT HR = 1.34 / 100 IU）的发生率，中风 (MT HR = 1.24; LT HR = 1.42)、感染 (MT HR = 1.13; LT HR = 1.10) 和/或设备故障 (MT HR = 1.22; LT HR = 1.46) 延长生存期缩短 (所有p ≤ 0.03 ）。

结论

LVAD 治疗的成功取决于在更多接受者中实现长期生存。1 年后，延长生存期受到不良事件和术后终末器官功能障碍的严重限制。目的地治疗意图的增长要求未来的 LVAD 研究设计有足够的随访时间，以捕捉超过 24 个月的结果。