2178Survival differences of left ventricle assist device carriers according to implantation eras - results from the European PCHF-VAD registry
Authors: Jakus N , Brugts J J , Timmermans P , Pouleur A C , Rubis P , Van Craenenbroeck E , Gaizauskas E , Grundmann S , Paolillo S , Barge-Caballero E , D'Amario D , Gkouziouta A , Milicic D , Ruschitzka F , Cikes M 
Published: October 2019

Abstract

Background
Developments in mechanical circulatory support have established left ventricular assist devices (LVAD) as a mainstay of therapy of advanced heart failure, resulting in improved outcomes in those implanted more recently - described as an “era effect” in the latest INTERMACS registry report. We aimed to study and describe the relevance of the era of device implant on outcomes in a European cohort of LVAD carriers.

Methods
448 patients with continuous flow LVADs have been included in the multicentre PCHF-VAD registry formed by 12 European centres (mean age 52±13 years, 82% male). Patient data were divided to quartiles according to date of LVAD implantation.

Results
Baseline data of patients stratified by implant date quartiles are shown in Table 1. By Cox regression analysis, only the latest quartile was associated with significantly better one year survival, compared to the earliest quartile (Q4 vs. Q1: HR 0.44, 95% CI: 0.22–0.88, p=0.02) (Figure 1). Using a forward stepwise selection process, age and INTERMACS class at implant were the only other significant predictors of outcome; the reduction in all-cause mortality for the patients implanted in the latest quartile remained significant when adjusting for these variables (HR 0.47, 95% CI: 0.23–0.95, p=0.035).
Table 1 Q1 (n=112) Q2 (n=112) Q3 (n=113) Q4 (n=111) p-value 6 Dec 2006–2 Jan 2012 3 Jan 2012–8 Dec 2014 9 Dec 2014–20 Jul 2016 21 Jul 2016–4 Apr 2018 CIED-D before VAD implant, n (%) 40 (35.7%) 50 (44.6%) 65 (57.5%) 85 (76.6%) <0.001 Age 47.8±13.8 53.4±11.9 54.0±12.5 54.3±12.9 <0.001 Female gender, n (%) 25 (22.3%) 22 (19.6%) 14 (12.4%) 20 (18.0%) 0.26 Arterial hypertension, n (%) 15 (13.4%) 34 (30.4%) 33 (29.2%) 20 (18.0%) 0.004 Diabetes mellitus, n (%) 13 (11.6%) 20 (17.9%) 26 (23.0%) 31 (27.9%) 0.017 Chronic kidney disease, n (%) 13 (11.6%) 20 (17.9%) 30 (26.5%) 39 (35.1%) <0.001 Coronary artery disease, n (%) 17 (15.2%) 23 (20.5%) 34 (30.1%) 37 (33.3%) 0.005 Chronic obstructive pulmonary disease, n (%) 1 (0.9%) 10 (8.9%) 14 (12.4%) 17 (15.3%) 0.002 Atrial fibrillation, n (%) 17 (15.2%) 33 (29.5%) 35 (31.0%) 43 (38.7%) 0.001 VAD type, HM2, n (%) 105 (93.8%) 90 (80.4%) 49 (43.4%) 2 (1.8%) <0.001 VAD type, HW, n (%) 0 (0.0%) 18 (16.1%) 42 (37.2%) 34 (30.6%) VAD type, HM3, n (%) 1 (0.9%) 0 (0.0%) 16 (14.2%) 70 (63.1%) VAD type, Other, n (%) 6 (5.4%) 4 (3.6%) 6 (5.3%) 5 (4.5%) VAD intention, BTT, n (%) 91 (86.7%) 88 (80.0%) 61 (58.1%) 65 (59.6%) <0.001 VAD intention, BTD, n (%) 8 (7.6%) 12 (10.9%) 28 (26.7%) 20 (18.3%) VAD intention, DT, n (%) 6 (5.7%) 10 (9.1%) 16 (15.2%) 24 (22.0%) INTERMACS class 1 27 (25.0%) 13 (11.7%) 23 (20.9%) 10 (9.3%) <0.001 INTERMACS class 2 41 (38.0%) 37 (33.3%) 19 (17.3%) 24 (22.2%) INTERMACS class 3 24 (22.2%) 27 (24.3%) 40 (36.4%) 48 (44.4%) INTERMACS class 4–7 16 (14.8%) 34 (30.6%) 28 (25.5%) 26 (24.1%) HM2, Heart Mate II; HW, HeartWare; HM3, HeartMate3; BTT, bridge to transplantation; BTD, bridge to decision; DT, destination therapy.
Figure 1

Conclusion
Despite a larger comorbidity burden, patients implanted most recently have better overall survival than those implanted in the earlier eras. This may be attributed to the increasing expertise of the implanting centres providing care for LVAD patients.