Left ventricular assist device implantation and clinical outcomes in the Netherlands.

Abstract

Left ventricular assist device (LVAD) therapy is an established treatment for advanced heart failure with reduced ejection fraction. We evaluated the characteristics and clinical outcomes of patients implanted with an LVAD in the Netherlands. Patients implanted with an LVAD in the Netherlands between 2016 and 2020 were included in the analysis. Baseline characteristics entered into this registry, as well as clinical outcomes (death on device, heart transplantation) and major adverse events (device dysfunction, major bleeding, major infection and cerebrovascular event), were evaluated. Atotal of 430patients were implanted with an LVAD; mean age was 55 ± 13years and 27% were female. The initial device strategy was bridge to transplant (BTT) in 50%, destination therapy (DT) in 29% and bridge to decision (BTD) in the remaining 21%. After afollow-up of 17months, 97 (23%) patients had died during active LVAD support. Survival was 83% at 1year, 76% at 2years and 54% at 5years. Patients implanted with an LVAD as aBTT had better outcomes compared with DT at all time points (1year 86% vs 72%, 2years 83% vs 59% and 5years 58% vs 33%). Major adverse events were frequently observed, most often major infection, major bleeding and cerebrovascular events (0.84, 0.33 and 0.09 per patient-year at risk, respectively) and were similar across device strategies. Patients supported with HeartMate3 had alower incidence of major adverse events. Long-term survival on durable LVAD support in the Netherlands is over 50% after 5years. Major adverse events, especially infection and bleeding, are still frequently observed, but decreasing with the contemporary use of HeartMate3 LVAD.