Outcome of durable mechanical circulatory support devices in a tertiary care hospital in Saudi Arabia

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure (HF) remains a significant cause of morbidity and mortality. Heart transplantation is the gold standard treatment for end stage heart failure. Durable mechanical circulatory support devices became a modality of treatment as bridge to transplantation or destination therapy because of the shortage of donor hearts. Objective To report the experience of durable mechanical circulatory devices in our tertiary care hospital as compared with the report of the International Society of Mechanically Assisted Circulatory Support (IMACS) registry. Results Between 2013 until December 2019, 73 durable mechanical circulatory support devices were implanted. Mean age 41.36 ±14.1 years and 83.6% of them were male. Etiology: 52.1% of the patients had dilated cardiomyopathy while 34.2% had ischemic cardiomyopathy. Age distribution: 45.2% of the patients were in the age group of 30-49 years while 32.9% were in the age group of 50-69 years. No devices were inserted in patients within the age group ≥70 years. Left ventricular assist devices with continuous pump flow accounted for 82.2% of implanted devices while biventricular support accounted for 15.1%. Total artificial hearts were implanted in 2.7% of the patients. INTERMACS categories at the time of implantation: 20.6% of patients were in INTERMACS I, INTERMACS II 38.4%, INTERMACS III 22%, INTERMACS IV17.6% while only 1.4% were INTERMACS V. Device strategy: 73.9% of devices were implanted as a bridge to candidacy for transplantation, 15.1 % were implanted as a bridge to cardiac recover, 8.2% were listed to heart transplantation while only 2.7% were left for destination therapy strategy. 50.7% of patients were discharged home after fulfilling education requirements. Forty per cent of the patients underwent heart transplantation. Major adverse events: 5.4% of the patients developed major cerebrovascular strokes after device implantation. Mediastinal significant bleeding and exploration occurred in 12.3% of patients and gastrointestinal bleeding in 8.2%. Driveline infection occurred in 16.4% of patients but only 2.7% had deep wound infection requiring urgent heart transplantation. Mortality on the device was 31.5%. Conclusion Our experience with mechanical circulatory support is similar to the reported major events and survival from the International Society of Mechanically Assisted Circulatory Support.