Abstract
BackgroundIn 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.MethodsWe 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.ResultsBetween 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.ConclusionsThe 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 registrationThis study was registered on the ClinicalTrials.gov database (NCT04263012).
Highlights
In Switzerland, long-term circulatory support programs have been limited to heart transplant centers
We evaluated the risk of postoperative right ventricular (RV) failure using predictive models [9, 10]
Retrospective analysis We reported common adverse events occurring after left ventricular assist device (LVAD) implantation as defined by the Interagency Registry for Mechanically Assisted Circulatory Support (INTE RMACS) [12]
Summary
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. Limited to patients with worsening end-stage heart failure awaiting heart transplant (HTx), left ventricular assist devices (LVADs) have undergone a tremendous development over the past three decades. Switzerland counts eight million inhabitants and five university hospitals, of which Zürich, Bern, and Lausanne The latter offer HTx and longterm mechanical circulatory support. The University Hospital Basel (USB) is a 750-bed hospital with 7200 employees, is rated as a non-transplant, comprehensive heart-failure center (CHFC) and had performed HTx until 2005. The purpose of this study was to describe the initial set-up of an LVAD program, focusing on its interdisciplinary and comprehensive aspects, and share our 5-year clinical results
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