Outcomes of Left Ventricular Assist Device for Patients with Hypertrophic Cardiomyopathy

Abstract

The treatment of end stage hypertrophic cardiomyopathy (HCM) is sometimes complicated because some cases of HCM are not suitable for LVAD. Scarce data exist on outcomes of continuous-flow (CF) LVAD support in these challenging patient cohorts. We evaluated the clinical outcomes of LVAD therapy for patients with HCM. Between 2005 and 2018, 191 consecutive patients underwent CF-LVAD implantation at Osaka University Hospital. Of these, we retrospectively compared the clinical outcomes between HCM (n=29) and idiopathic dilated cardiomyopathy (DCM, n=106) patients with CF-LVAD support. The primary outcome was all-cause mortality. Median follow-up time was 815 days (interquartile range [IQR]: 373-1172). There were no significant differences between the two groups about patient's baseline characteristics. HCM group had significant smaller left ventricle (LV) than DCM group. [LV end-diastolic diameter: 67 (IQR: 55-71) vs 72 (IQR: 62-82), p<0.05] In short-term outcome, there was no significant difference about in-hospital mortality. [HCM vs DCM; 2 (7%) vs 4 (4%), p=0.47] Regarding postoperative complication, HCM group required more frequent right ventricular assist device (RVAD) support than DCM group. [8 (28%) vs 4 (4%), p<0.01] In long-term outcome, the overall survival rate at 1 and 3 years was 89% and 74% in HCM group, 92% and 90% in DCM group, respectively (p=0.03). (Figure A) During the follow up period, HCM group had significantly more LVAD pump exchanges than DCM group. [hazard ratio, 4.10 95% confidence interval, 1.67 to 10.1; p=0.002] (Figure B) CONCLUSION: The long-term outcome of LVAD therapy for patients with HCM is still challenging. In particular, careful attention is required for right heart function.