Continuous-Flow Left Ventricular Assist Device Implantation in Patients With a Small Left Ventricle

Masashi Kawabori, Chitaru Kurihara, Tadahisa Sugiura, William E. Cohn, Andrew B. Civitello, O. Howard Frazier, Jeffrey A. Morgan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Having a preoperative small left ventricle (LV) has been associated with higher complication and mortality rates after left ventricular assist device (LVAD) implantation; however, the outcomes after continuous-flow LVAD implantation have not been well studied. This is the first large-scale analysis of long-term survival after continuous-flow LVAD implantation in patients with a preoperative small LV. Methods: Our cohort comprised 511 patients who underwent primary implantation of a HeartMate II (n = 393 [Thoratec, Pleasanton, CA]) or HeartWare HVAD (n = 118 [HeartWare International, Framingham, MA]) at our institution between November 2003 and March 2016. Preoperative small LV was defined as having an LV end-diastolic diameter of 5.5 cm or less. HeartMate II and HVAD recipients with a small LV were compared with patients not having a small LV in terms of perioperative characteristics, complications, and long-term survival. Results: The HeartMate II was implanted in 393 patients (non-small LV, n = 352; small LV, n = 41), and the HVAD was implanted in 118 patients (non-small LV, n = 94; small LV, n = 24). For the HeartMate II recipients, the 24-month survival rate was 66.8% for the non-small LV patients and 56.1% for the small LV patients (p = 0.17); non-small LV patients had significantly better overall survival (p = 0.02). For the HVAD recipients, the 24-month survival rate was 71.3% for the non-small LV patients and 70.8% for the small LV patients (p = 0.96); these groups showed no significant difference in overall survival (p = 0.89). Conclusions: Although the indications for implantation are different for these two devices, our study suggests that the survival advantage associated with HVAD implantation should be considered when selecting a device for small LV patients.

Original languageEnglish (US)
Pages (from-to)799-806
Number of pages8
JournalAnnals of Thoracic Surgery
Volume105
Issue number3
DOIs
StatePublished - Mar 2018
Externally publishedYes

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Heart-Assist Devices
Heart Ventricles
Survival
Survival Rate
Equipment and Supplies

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Continuous-Flow Left Ventricular Assist Device Implantation in Patients With a Small Left Ventricle. / Kawabori, Masashi; Kurihara, Chitaru; Sugiura, Tadahisa; Cohn, William E.; Civitello, Andrew B.; Frazier, O. Howard; Morgan, Jeffrey A.

In: Annals of Thoracic Surgery, Vol. 105, No. 3, 03.2018, p. 799-806.

Research output: Contribution to journalArticle

Kawabori, Masashi ; Kurihara, Chitaru ; Sugiura, Tadahisa ; Cohn, William E. ; Civitello, Andrew B. ; Frazier, O. Howard ; Morgan, Jeffrey A. / Continuous-Flow Left Ventricular Assist Device Implantation in Patients With a Small Left Ventricle. In: Annals of Thoracic Surgery. 2018 ; Vol. 105, No. 3. pp. 799-806.
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abstract = "Background: Having a preoperative small left ventricle (LV) has been associated with higher complication and mortality rates after left ventricular assist device (LVAD) implantation; however, the outcomes after continuous-flow LVAD implantation have not been well studied. This is the first large-scale analysis of long-term survival after continuous-flow LVAD implantation in patients with a preoperative small LV. Methods: Our cohort comprised 511 patients who underwent primary implantation of a HeartMate II (n = 393 [Thoratec, Pleasanton, CA]) or HeartWare HVAD (n = 118 [HeartWare International, Framingham, MA]) at our institution between November 2003 and March 2016. Preoperative small LV was defined as having an LV end-diastolic diameter of 5.5 cm or less. HeartMate II and HVAD recipients with a small LV were compared with patients not having a small LV in terms of perioperative characteristics, complications, and long-term survival. Results: The HeartMate II was implanted in 393 patients (non-small LV, n = 352; small LV, n = 41), and the HVAD was implanted in 118 patients (non-small LV, n = 94; small LV, n = 24). For the HeartMate II recipients, the 24-month survival rate was 66.8{\%} for the non-small LV patients and 56.1{\%} for the small LV patients (p = 0.17); non-small LV patients had significantly better overall survival (p = 0.02). For the HVAD recipients, the 24-month survival rate was 71.3{\%} for the non-small LV patients and 70.8{\%} for the small LV patients (p = 0.96); these groups showed no significant difference in overall survival (p = 0.89). Conclusions: Although the indications for implantation are different for these two devices, our study suggests that the survival advantage associated with HVAD implantation should be considered when selecting a device for small LV patients.",
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T1 - Continuous-Flow Left Ventricular Assist Device Implantation in Patients With a Small Left Ventricle

AU - Kawabori, Masashi

AU - Kurihara, Chitaru

AU - Sugiura, Tadahisa

AU - Cohn, William E.

AU - Civitello, Andrew B.

AU - Frazier, O. Howard

AU - Morgan, Jeffrey A.

PY - 2018/3

Y1 - 2018/3

N2 - Background: Having a preoperative small left ventricle (LV) has been associated with higher complication and mortality rates after left ventricular assist device (LVAD) implantation; however, the outcomes after continuous-flow LVAD implantation have not been well studied. This is the first large-scale analysis of long-term survival after continuous-flow LVAD implantation in patients with a preoperative small LV. Methods: Our cohort comprised 511 patients who underwent primary implantation of a HeartMate II (n = 393 [Thoratec, Pleasanton, CA]) or HeartWare HVAD (n = 118 [HeartWare International, Framingham, MA]) at our institution between November 2003 and March 2016. Preoperative small LV was defined as having an LV end-diastolic diameter of 5.5 cm or less. HeartMate II and HVAD recipients with a small LV were compared with patients not having a small LV in terms of perioperative characteristics, complications, and long-term survival. Results: The HeartMate II was implanted in 393 patients (non-small LV, n = 352; small LV, n = 41), and the HVAD was implanted in 118 patients (non-small LV, n = 94; small LV, n = 24). For the HeartMate II recipients, the 24-month survival rate was 66.8% for the non-small LV patients and 56.1% for the small LV patients (p = 0.17); non-small LV patients had significantly better overall survival (p = 0.02). For the HVAD recipients, the 24-month survival rate was 71.3% for the non-small LV patients and 70.8% for the small LV patients (p = 0.96); these groups showed no significant difference in overall survival (p = 0.89). Conclusions: Although the indications for implantation are different for these two devices, our study suggests that the survival advantage associated with HVAD implantation should be considered when selecting a device for small LV patients.

AB - Background: Having a preoperative small left ventricle (LV) has been associated with higher complication and mortality rates after left ventricular assist device (LVAD) implantation; however, the outcomes after continuous-flow LVAD implantation have not been well studied. This is the first large-scale analysis of long-term survival after continuous-flow LVAD implantation in patients with a preoperative small LV. Methods: Our cohort comprised 511 patients who underwent primary implantation of a HeartMate II (n = 393 [Thoratec, Pleasanton, CA]) or HeartWare HVAD (n = 118 [HeartWare International, Framingham, MA]) at our institution between November 2003 and March 2016. Preoperative small LV was defined as having an LV end-diastolic diameter of 5.5 cm or less. HeartMate II and HVAD recipients with a small LV were compared with patients not having a small LV in terms of perioperative characteristics, complications, and long-term survival. Results: The HeartMate II was implanted in 393 patients (non-small LV, n = 352; small LV, n = 41), and the HVAD was implanted in 118 patients (non-small LV, n = 94; small LV, n = 24). For the HeartMate II recipients, the 24-month survival rate was 66.8% for the non-small LV patients and 56.1% for the small LV patients (p = 0.17); non-small LV patients had significantly better overall survival (p = 0.02). For the HVAD recipients, the 24-month survival rate was 71.3% for the non-small LV patients and 70.8% for the small LV patients (p = 0.96); these groups showed no significant difference in overall survival (p = 0.89). Conclusions: Although the indications for implantation are different for these two devices, our study suggests that the survival advantage associated with HVAD implantation should be considered when selecting a device for small LV patients.

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