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- Title
5-year results of a newly implemented mechanical circulatory support program for terminal heart failure patients in a Swiss non-cardiac transplant university hospital.
- Authors
Schaeffer, Thibault; Pfister, Otmar; Mork, Constantin; Mohacsi, Paul; Rueter, Florian; Scheifele, Simon; Morgen, Anne; Zenklusen, Urs; Doebele, Thomas; Maurer, Markus; Erb, Joachim; Fassl, Jens; Cueni, Nadine; Siegemund, Martin; Pargger, Hans; Gahl, Brigitta; Osswald, Stefan; Eckstein, Friedrich; Grapow, Martin
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.<bold>Trial Registration: </bold>This study was registered on the ClinicalTrials.gov database ( NCT04263012 ).
- Subjects
BASEL (Switzerland); SWITZERLAND; HEART failure patients; UNIVERSITY hospitals; HEART assist devices; PATIENT selection; HEART transplantation; STROKE prevention; ACADEMIC medical centers; RETROSPECTIVE studies; KAPLAN-Meier estimator; HEART failure; COMPLICATIONS of prosthesis; LONGITUDINAL method
- Publication
Journal of Cardiothoracic Surgery, 2021, Vol 16, Issue 1, p1
- ISSN
1749-8090
- Publication type
journal article
- DOI
10.1186/s13019-021-01447-5