Abstract 16929: Are Patients Implanted with a Ventricular Assist Device as Destination Therapy Created Equal? Analysis of Outcomes by Implant Indications

Abstract

Introduction: A growing number of patients are implanted with a continuous-flow left ventricular assist device (CF-LVAD) for destination therapy (DT). Hypothesis: We sought to determine if indication for DT was associated with adverse events and survival. Methods: Between May 2004 and May 2014, 211 patients (age 66 (19-82), 89% male) underwent implantation of a HeartMate II CF-LVAD. The cohort was stratified according to primary listed indication for DT at time of implant: Group 1=advanced age (n=124, 59%); Group 2=high BMI (n=33, 16%), and Group 3=end-organ comorbidities (n=54, 25%). DT patients who later became BTT were eliminated for homogeneity. Results: Follow-up was available in all patients for a total of 376 patient-years of support (median 1.4 years). Preoperative characteristics (creatinine 1.5, INTERMACS 3, IABP 49%) were comparable between groups (all p>0.05). Overall 1, 3 and 5-year survival was 81%, 58%, and 41%, respectively. Kaplan-Meier analysis revealed comparable survival between groups stratified by DT indications (Figure, p=0.07). While gastrointestinal (GI) bleeding was more frequent in patients implanted for advanced age DT indications (p=0.01, group 1 vs group 2 and 3), the incidence of adverse events (pump thrombus/exchange, stroke) was comparable between groups. After adjusting for covariates (creatinine, hemoglobin, prior sternotomy and diabetes), Cox regression analysis demonstrated only preoperative renal dysfunction (HR 1.86 CI 1.28, 2.69; p=0.001) and lower Hemoglobin (HR 0.82 CI 0.71, 0.95; p=0.008) were associated with late mortality after implantation. Conclusions: Advanced age remains the most frequent contemporary indication for DT in patients undergoing CF-LVAD implantation. Indication for DT implantation does not influence long-term survival. Elderly patients may be at greater risk of GI bleeding events. These results continue to favor a uniform selection process across the spectrum of DT indications.