Comparison of Early and Late Postoperative Outcomes Between INTERMACS 1/2 vs. 3/4

Abstract

<h3>Purpose</h3> The INTERMACS profiles are established as important selection and prognostic criteria for Left Ventricular Assist Devices (LVAD) implantation. We sought to investigate the correlation of higher acuity INTERMACS profile and post-LVAD implantation outcomes in carefully selected and optimized patients. <h3>Methods</h3> We conducted a retrospective analysis of all HeartMate 3 LVAD (HM3) implantations in our institution between September 2015 and April 2021. Baseline characteristics and clinical outcomes were compared based on pre-implantation INTERMACS profiles: 1 and 2 (IP1-2) vs. 3 and 4 (IP3-4). Our primary study endpoint was the composite of stroke events and death from time of HM3 implantation through late follow-up. <h3>Results</h3> Of 234 patients implanted with a HM3 during the study period, 116 (49.6%) presented in cardiogenic shock IP1-2, while 118 (50.4%) were less acute IP3-4 (Table 1). Patients in IP1-2 at time of LVAD implantation were younger with de-novo heart failure and worse end-organ function. Postoperatively, patients in the IP1-2 group experienced higher rates of early adverse events including severe right ventricular failure (9% vs. 3%, p=0.025) and prolonged hospital length of stay. There was no statistically significant difference in the Kaplan-Meier estimator (Figure 1.) for the composite end-point of death and stroke between IP groups. <h3>Conclusion</h3> INTERMACS 1/2 patients implanted with HM3 LVAD were younger, had longer intubation times, and longer ICU and hospital lengths of stay. Clinical outcomes were similar between the groups with INTERMACS 3/4 patients showing a trend toward a lower composite event rate of stroke and death.