Outcomes of LVAD Implantation in Ischemic versus Nonischemic Cardiomyopathy

Abstract

Purpose Left ventricular assist devices (LVADs) are a popular option for left ventricular support in bridging patients to heart transplantation or as destination therapy. However, the effect of heart failure etiology on outcomes after LVAD implantation has not yet been elucidated. Methods Between 2008 and 2018, a total of 549 patients with either ischemic cardiomyopathy (ICM) or nonischemic cardiomyopathy (NICM) underwent implantation of a continuous-flow LVAD our institution. ICM was defined by history of myocardial infarction or revascularization, coronary angiography showing ≥75% stenosis of the left main or proximal left anterior descending coronary arteries or ≥75% stenosis of two or more epicardial vessels. We identified 301 (54.8%) patients with NICM and 248 (45.2%) patients with ICM, and compared postoperative survival and adverse events in patients with ICM versus NICM. Results NICM patients were more likely to be female (22.9% vs 17.8%, p=0.08). Survival was similar between both groups with 30 day, 6 month, and 1 year survivals of 93%, 81%, and 72%, respectively, for ICM patients versus 91%, 81%, and 74%, respectively, for NICM patients (p=0.5) (Figure 1). Etiology of heart failure was not an independent predictor of survival in multivariate logistic regression analysis (p=0.84). There was no significant difference in adverse events including stroke, sepsis, or pump infection between the two groups. Conclusion The etiology of heart failure did not appear to significantly affect outcomes after LVAD implantation.