Left Ventricular Assist Device Treatment Research Articles

Right heart failure with left ventricular assist devices: Preoperative, perioperative and postoperative management strategies. A clinical consensus statement of the Heart Failure Association (HFA) of the ESC

AbstractRight heart failure (RHF) following implantation of a left ventricular assist device (LVAD) is a common and potentially serious condition with a wide spectrum of clinical presentations with an unfavourable effect on patient outcomes. Clinical scores that predict the occurrence of right ventricular (RV) failure have included multiple clinical, biochemical, imaging and haemodynamic parameters. However, unless the right ventricle is overtly dysfunctional with end‐organ involvement, prediction of RHF post‐LVAD implantation is, in most cases, difficult and inaccurate. For these reasons optimization of RV function in every patient is a reasonable practice aiming at preparing the right ventricle for a new and challenging haemodynamic environment after LVAD implantation. To this end, the institution of diuretics, inotropes and even temporary mechanical circulatory support may improve RV function, thereby preparing it for a better adaptation post‐LVAD implantation. Furthermore, meticulous management of patients during the perioperative and immediate postoperative period should facilitate identification of RV failure refractory to medication. When RHF occurs late during chronic LVAD support, this is associated with worse long‐term outcomes. Careful monitoring of RV function and characterization of the origination deficit should therefore continue throughout the patient's entire follow‐up. Despite the useful information provided by the echocardiogram with respect to RV function, right heart catheterization frequently offers additional support for the assessment and optimization of RV function in LVAD‐supported patients. In any patient candidate for LVAD therapy, evaluation and treatment of RV function and failure should be assessed in a multidimensional and multidisciplinary manner.

Economic aspects of long-term left ventricular assist device treatment for chronic heart failure.

Technological advances and the current shortage of donor organs have contributed to an increase in the number of left ventricular assist device (LVAD) implantations in patients with end-stage heart failure. Demographic change and medical progress might raise the number of these patients, resulting in a further increase in the number of LVAD implantations. The aim of this study was to evaluate the long-term costs of LVAD therapy and identify diagnoses resulting in expensive stays. In this retrospective analysis of prospectively collected data, all patients after implantation of a second- or third-generation LVAD by 31 March 2022 were included. In addition to demographic and survival data, revenues and case mix points were determined for each patient. Of the 163 patients included, 75.5% were male. The mean age at LVAD implantation was 52±14years. The mean survival was 1458±127days. During follow-up, the total inpatient treatment time per patient was 70±87days. The average duration of outpatient treatment was 55.1%, based on the total duration of support. The average revenue per patient for the implant stay was $193192.35±$111801.29, for inpatient readmissions $52068.96±$116630.00, and for outpatient care $53195.94±$62363.53. LVAD implantation in patients with end-stage heart failure leads to improved survival but a significant increase in treatment costs. Further multi-centre studies are necessary in order to be able to assess the effects of long-term LVAD treatment on the healthcare system.

426 A Beat Away from Precision Medicine: Characterizing Human Cardiac Fibroblast Responsiveness to Hemodynamic Unloading in Heart Failure with Reduced Ejection Fraction

OBJECTIVES/GOALS: Myocardial interstitial fibrosis leads to high hemodynamic load resulting in heart failure (HFrEF). Previous studies show that treatment with a left ventricular assist device (LVAD) does not reduce fibrosis. We hypothesize that human cardiac fibroblasts are highly activated in HFrEF and remain unresponsive to hemodynamic unloading by LVAD. METHODS/STUDY POPULATION: Forty human subjects with HFrEF undergoing LVAD implantation were enrolled to provide a portion of myocardium routinely removed during LVAD placement. In addition, 7 biopsies previously collected from transplanted hearts with extended LVAD treatment were also evaluated (LVEX). RESULTS/ANTICIPATED RESULTS: Quantification of PSR-stained sections reveals a significant increase in collagen content in the HFrEF tissue (CVF = 2.8) compared to control tissues (CVF = 0.9) that remained elevated in LVEX hearts (CVF = 3.1). HCFs from LV biopsies were isolated and grown to confluence. HCFs from HFrEF patients and control HCFs were plated on substrates with stiffnesses reflective of normal myocardium (2kPa) or HFrEF myocardium (8kPa). Cells were collected at 4- and 7-day time points and levels of collagen I and alpha-smooth muscle actin were quantified by western blot analysis. Control HCFs were responsive to changes in substrate stiffness producing more Col I and a-SMA on 8kPa versus 2kPa, HCFs from HFrEF patients were unresponsive to changes in stiffness exhibiting no significant difference in protein production on 2 vs. 8kPa. DISCUSSION/SIGNIFICANCE: Our data suggests that HCFs isolated from the failing myocardium do not respond to changes in mechanical load and might contribute to persistent increases in fibrosis. These findings bring us one step closer to elucidating mechanisms behind fibrosis in HFrEF which could lead to targeted therapies to improve patient outcomes from LVAD support.

Calcium channel blockers and clinical outcomes in patients with continuous-flow left ventricular assist devices.

Current guidelines suggest calcium channel blockers (CCBs) as the second or third option for blood pressure management in patients with left ventricular assist device (LVAD). However, the clinical outcomes of patients with LVAD who receive CCBs remain unclear. Our study aims to analyse the association of CCBs with clinical outcomes in patients after LVAD implantation. This is a retrospective analysis based on the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) from 2006 to 2017, and adult patients who were alive with LVAD and CCB treatment information at 6months after implantation were included. Among 10717 patients, 1369 received CCBs 6months after implantation, and there was an increasing trend of CCB use after LVAD. Patients receiving CCB therapy at 6months had a similar 5year survival rate to those not receiving CCB [49.6%, 95% confidence interval (CI): 47.5-51.7% vs. 51.1%, 95% CI: 45.3-56.7%]. In both Cox and competing risk regressions after adjusting for confounding factors, CCB treatment at 6months after implantation was not associated with long-term mortality [hazard ratio (HR): 1.03, 95% CI: 0.91-1.17, P=0.624 and subdistribution HR (SHR): 1.07, 95% CI: 0.95-1.22, P=0.260]. Consistently, in time-varying models, CCB treatment was not linked to long-term mortality (HR: 0.97, 95% CI: 0.87-1.09, P=0.682 and SHR: 1.05, 95% CI: 0.94-1.18, P=0.359). This null association remained in subgroup analysis according to device strategy and propensity-matching analyses. Neurological dysfunction, stroke, bleeding, rehospitalization, and renal dysfunction were more likely to occur among those with CCB when compared with those without CCB treatment. In patients with LVAD, CCB therapy fails to show benefits in long-term survival and is associated with increased incidences of neurological dysfunction, bleeding, renal dysfunction, and rehospitalization.

Abstract P2111: Characterizing Human Cardiac Fibroblast Responsiveness To Hemodynamic Unloading In Heart Failure With Reduced Ejection Fraction

Background: Myocardial interstitial fibrosis is a common pathology in cardiomyopathies leading to ventricular dilation and increased hemodynamic load that result in heart failure with reduced ejection fraction (HFrEF). Previous research has shown that HFrEF patients treated with a left ventricular assist device (LVAD) undergo hemodynamic unloading resulting in at least partial cardiomyocyte recovery. However, evidence supports that these patients do not experience a regression of fibrosis and demonstrate, in some cases, a worsening of fibrosis after LVAD treatment. Purpose: We hypothesize that human cardiac fibroblasts (HCFs) are constitutively activated in HFrEF myocardium but remain unresponsive to hemodynamic unloading with LVAD placement. Methods and Results: Forty human subjects with HFrEF undergoing LVAD implantation were enrolled to provide a portion of myocardium routinely removed during LVAD placement. In addition, 7 biopsies previously collected from transplanted hearts with extended LVAD treatment were also evaluated (LVEX). Quantification of PSR stained sections revealed a significant increase in collagen content in the HFrEF tissue (Collagen volume fraction % (CVF) = 2.8±0.2) in comparison to control tissues (CVF = 0.9±0.2) that remained elevated in LVEX hearts (CVF = 3.1±0.3). HCFs derived from biopsies received at LVAD placement were isolated and grown to confluence. HCFs from HFrEF patients and control HCFs from healthy donors were then plated on substrates with mechanical stiffnesses reflective of either normal myocardium (2kPa) or failing myocardium (8kPa). Cells were collected at 4- and 7-day timepoints and levels of collagen I (Col I) and alpha-smooth muscle actin (α-SMA) were quantified through western blot analysis with β-actin as a loading control. Whereas control HCFs were responsive to changes in substrate stiffness producing more Col I and α-SMA on 8kPa versus 2kPa, HCFs from HFrEF patients were unresponsive to changes in stiffness exhibiting no significant difference in production on 2 vs. 8kPa. Conclusion: These data suggest that HCFs isolated from the failing myocardium do not respond to changes in mechanical load and hence, might contribute to persistent increases in fibrosis in failing and unloaded hearts.

Retrospective evaluation of the effect of nutritional status of patients with left ventricular assist device on clinical results in the postoperative period

Abstract Funding Acknowledgements Type of funding sources: None. Objective Malnutrition in patients undergoing left ventricular assist device (LVAD) implantation has negative consequences, such as infection and limited functional capacity. The effects of nutritional status of patients with LVAD on their clinical outcomes were investigated. Methods 116 records of patients with LVAD implantation were retrospectively analysed. For nutritional evaluation, nutrition risk score NRI score was calculated to divide the patients into two groups with and without malnutrition risk. Demographic and clinical data before LVAD, early postoperative adverse events after LVAD, prognostic data, and laboratory findings were analysed. Results 116 patients (6 females, 110 man) had a mean age of 60.5±9,46 years; Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) scores were determined as 1 (n=11), 2 (n=36), 3 (n=65), and 4 (n=4). Forty four patients (44%) (19 mild, 6 moderate, 19 severe) had MR. The MR was higher in patients with preoperative INTERMACS score 1, low level of haemoglobin and albumin The incidence of adverse events was found to be significantly higher in patients with higher preoperative grade NRI (death during the pooperative period, bleeding). Conclusion In the early postoperative period, a MR of 44% was detected in patients who underwent LVAD. Total 72.2 % patients had any adverse events. We found that the presence of MR was effective in predicting postoperative adverse events according to NRI score before LVAD treatment.

Left ventricular assist device implantation combined with hemiarch replacement for severe aortic atherosclerosis.

Implantation of the left ventricular assist device (LVAD) has emerged as a widely employed therapeutic approach for specifically chosen individuals suffering from severe heart failure. Stroke is a well-known complication of LVAD implantation. Concomitant aortic surgeries in patients requiring LVAD implantation to avoid outflow graft anastomosis to a severe atherosclerotic aorta are unknown. We illustrate a successful LVAD implantation with hemiarch replacement for severe aortic atherosclerosis to decrease the risk of postoperative stroke. A 72-year-old male patient with advanced heart failure has chosen to undergo LVAD treatment. Preoperative examinations detected severe atherosclerosis in the ascending aorta. It was determined that clamping the ascending aorta and directly connecting the outflow graft could increase the risk of stroke after surgery. Therefore, it was decided to replace the diseased ascending aorta entirely. The HeartMate 3 was implanted under cardiopulmonary bypass (CPB) using right axillary artery cannulation. And moderate hypothermia and bilateral antegrade cerebral perfusion were utilized to perform hemiarch replacement. Subsequently, the outflow graft was connected to an artificial ascending aortic graft. The patient did not exhibit any specific complications, such as neurological abnormalities, after the surgery. Based on our observations, it appears that LVAD implantation combined with aortic replacement could be a viable option for specific patients, particularly those who have a perioperative stroke risk due to aortic atherosclerosis.

Continuous-flow left ventricular assist device treatment for arrhythmogenic right ventricular cardiomyopathy complicated by advanced biventricular failure - University of Tokyo experiences.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyocyte disease characterized by intractable ventricular arrhythmia in the majority of affected patients. Some of these patients also manifest right ventricular dysfunction and heart failure symptoms. Fatal ventricular arrhythmia has been the primary cause of death in ARVC patients. However, increased early recognition of ARVC and improvement in arrhythmic risk stratification and treatment have dramatically improved survival. A small proportion of the patients are further complicated by left ventricular impairment at the late phase in addition to right heart failure, for whom only heart transplantation is the last resort. Because of the relative rarity of ARVC with biventricular failure, no consensus or guideline has been reported on how to effectively support these patients with a mechanical circulatory device. Herein, four ARVC patients with biventricular failure were presented who were successfully bridged to heart transplantation after long-term support by isolated continuous-flow LVAD.

Clinical characteristics and long-term outcomes in patients with peripartum cardiomyopathy (PPCM) receiving left ventricular assist devices (LVAD).

Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure (HF), presenting with left ventricular (LV) systolic dysfunction either at the end of pregnancy or in the months following delivery. In rare cases, PPCM leads to severe impairment of LV function, refractory cardiogenic shock or advanced HF. LV assist devices (LVAD) have been shown to be a feasible treatment option in advanced HF. However, little is known about long-term outcomes and prognosis of PPCM patients undergoing LVAD implantation. A retrospective analysis of data from PPCM patients undergoing LVAD implantation in two tertiary centers with respect to long-term outcomes was performed. Twelve patients of median age 30 (18-39) years were included. Eight patients were experiencing cardiogenic shock (INTERMACS 1) at implantation. Seven patients were implanted within 1 month of their PPCM diagnosis. Median duration of LVAD support was 19 (2-92) months with median follow up of 67 (18-136) months (100% complete). In-hospital and 1-year mortality were 0% and 8.3%, respectively. Two patients died on LVAD support, four patients were successfully bridged to transplantation, two patients are still on LVAD, and four were successfully weaned due to sufficient LV recovery (one died after LV function deteriorated again). LVAD treatment of decompensated end-stage PPCM is feasible. Early LVAD provision led to hemodynamic stabilization in our cohort and facilitated safe LV recovery in one third of these young female patients.

A multidisciplinary approach for the emergency care of patients with left ventricular assist devices: A practical guide

The use of a left ventricular assist device (LVAD) as a bridge-to-transplantation or destination therapy to support cardiac function in patients with end-stage heart failure (HF) is increasing in all developed countries. However, the expertise needed to implant and manage patients referred for LVAD treatment is limited to a few reference centers, which are often located far from the patient's home. Although patients undergoing LVAD implantation should be permanently referred to the LVAD center for the management and follow-up of the device also after implantation, they would refer to the local healthcare service for routine assistance and urgent health issues related to the device or generic devices. Therefore, every clinician, from a bigger to a smaller center, should be prepared to manage LVAD carriers and the possible risks associated with LVAD management. Particularly, emergency treatment of patients with LVAD differs slightly from conventional emergency protocols and requires specific knowledge and a multidisciplinary approach to avoid ineffective treatment or dangerous consequences. This review aims to provide a standard protocol for managing emergency and urgency in patients with LVAD, elucidating the role of each healthcare professional and emphasizing the importance of collaboration between the emergency department, in-hospital ward, and LVAD reference center, as well as algorithms designed to ensure timely, adequate, and effective treatment to patients with LVAD.

Percutaneous approach to left ventricular assist device decommissioning.

ObjectiveTo assess the outcomes of a single‐center experience with percutaneous left ventricular assist device (LVAD) decommissioning.BackgroundPatients with LVADs may eventually require their removal, either due to recovery of left ventricular function or recurrent complications. Traditionally, withdrawal of LVAD support has been managed with surgical device explantation, which carries significant procedural risks. Transcatheter LVAD decommissioning, with outflow graft occlusion and driveline transection, has recently been described as an alternative to surgical removal.MethodsHere, we report on a retrospective cohort of five consecutive cases treated with transcatheter LVAD decommissioning.ResultsThe procedure was effective in all cases, and no patient experienced procedure‐related complications. At midterm follow‐up, the three patients who had myocardial function recovery were alive and had not experienced heart failure‐related symptoms or complications.ConclusionPercutaneous LVAD decommissioning appears to be a safe and effective approach to LVAD treatment discontinuation.

Association Between Center Level Characteristics And 1-Month Post-LVAD Implant Risk Standardized Mortality Rates

<h3>Background</h3> As more durable continuous flow (CF) left ventricular assist device (LVAD) are implanted, the number of implanting centers has increased. Whether center level characteristics influence post-implantation outcomes is not fully defined. Therefore, we sought to determine center level characteristics associated with risk standardized mortality rates (RSMR) at 1-month post-implant. <h3>Methods</h3> Data from 167 centers that implanted CF-LVADs in 19,503 patients between 2008-2017 in the INTERMACS were analyzed. The 1-month post-implantation center RSMR was generated with a multivariable logistic regression model adjusting for 50 patient-level characteristics at implantation for all LVAD treatment strategies. Data from patients who were transplanted within 1-month or who had ≥5 missing variables were excluded. RSMR estimates underwent Bayesian correction to account for the influence of unbalanced inter-center CF LVAD volumes. Center-level characteristics were compared by the Cochran-Armitage trend or Chi-square tests across tertiles of the 1-month RSMR where appropriate. <h3>Results</h3> The overall median [25-75^th quartile] 1-month RSMR was 4% (1-6%). Median 1-month RSMR by center tertiles was 0% (0-1%), 4% (3-4%), and 7% (6-9%) respectively. Both greater annual and greater cumulative center LVAD volume were associated with lower 1-month RSMR (P <0.04 for both, figure A-B). Higher annual destination therapy CF-LVAD implantation volume (P=0.03), but not bridge-to-transplant CF-LVAD implantation volume (P=0.14) was associated with a lower 1-month RSMR. An implanting center's percentage of destination therapy or bridge-to-transplant strategy CF-LVAD devices implanted was also not associated with 1-month RSMR (Figure C-F). Higher rates of a concomitant mitral valve repair, a sternal implant approach, and intraoperative ECMO or IABP removal were each associated with a lower 1-month RSMR (P<0.05 for all). Less cardiopulmonary bypass time (P<0.01), but not total surgical time (P=0.43) was associated with a lower 1-month RSMR. Lastly, there was no association with the percentage of patients with INTERMACs profile 1 and 1-month RSMR (P=0.80). <h3>Conclusions</h3> When controlling for patient-level characteristics, higher LVAD implantation volumes, higher absolute rates of DT LVAD volumes, and certain patient-management strategies by center were associated with lower 1-month RSMR. These data identify potential patterns of care by center that may influence short-term post-LVAD outcomes.

Examination of a patient with left ventricular assist device in an emergency condition — proposal for adaptation of the ABCDE examination algorithm

Heart failure is becoming a medical issue that concerns more and more patients. The most effective treatment method is heart transplantation, however, more people are waiting for the procedure than there are available donors. The improvement of left ventricular assist device (LVAD) method was possible because of the joining forces of technological and medical advances. In recent years more patients have undergone the LVAD treatment. It has been a considerable challenge for medics in prehospital conditions. Device malfunction, bleeding, chest pain, or collapse pose a threat to life for those patients. The aim of this paper was to adjust the ABCDE examination algorithm to be applied for patients with LVAD. Additionally, the author has described the method in detail. The article itself and the modification of the algorithm are based on the analyses of available source literature. The biggest challenge for medics who examine patients with LVAD is a lack of pulse and inability to measure the pressure in a classical method. The most visible differences in the examination scheme have been observed in points C and E. The authors have identified the need for simulation-based trainings dedicated to medical staff working in prehospital conditions. Additionally, a special system informing emergency services about LVAD patients living in their area should be implemented.

Preoperative Computed Tomography Assessment of Risk of Right Ventricle Failure After Left Ventricular Assist Device Placement.

Identification of patients who are at a high risk for right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation is of critical importance. Conventional tools for predicting RVF, including two-dimensional echocardiography, right heart catheterization (RHC), and clinical parameters, generally have limited sensitivity and specificity. We retrospectively examined the ability of computed tomography (CT) ventricular volume measures to identify patients who experienced RVF after LVAD implantation. Between September 2017 and November 2021, 92 patients underwent LVAD surgery at our institution. Preoperative CT-derived ventricular volumes were obtained in 20 patients. Patients who underwent CT evaluation had a similar demographics and rate of RVF after LVAD as patients who did not undergo cardiac CT imaging. In the study cohort, seven of 20 (35%) patients experienced RVF (2 unplanned biventricular assist device, 5 prolonged inotropic support). Computed tomography-derived right ventricular end-diastolic and end-systolic volume indices were the strongest predictors of RVF compared with demographic, echocardiographic, and RHC data with areas under the receiver operating curve of 0.79 and 0.76, respectively. Computed tomography volumetric assessment of RV size can be performed in patients evaluated for LVAD treatment. RV measures of size provide a promising means of pre-LVAD assessment for postoperative RV failure.

A pilot clinical trial of a self-management intervention in patients with a left ventricular assist device.

Self-management is a health behavior known to predict treatment outcomes in patients with multiple co-morbidities and/or chronic conditions. However, the self-management process and outcomes in the left-ventricular assist device (LVAD) population are understudied. This pilot randomized control trial (RCT) evaluated the feasibility of a novel "smartphone app-directed and nurse-supported self-management intervention" in patients implanted with durable LVADs. Assessments included behavioral (self-efficacy and adherence), clinical (complications), and healthcare utilization (unplanned clinic, emergency room (ER) visits, and re-hospitalization) outcomes, completed at baseline (pre-hospital discharge) and months 1, 3, and 6 post-hospital discharge. Intervention patients (n = 14) had favorable patterns/trends of results across study outcomes than control patients (n = 16). Notably, intervention patients had much lower complications and healthcare utilization rates than controls. For example, intervention patients had 2 (14.3%) driveline infections in 6months while control patients had 3 (19.0%). Additionally, at month 3, intervention patients had 0% ER visits versus 36% of control patients. At month 6, the mean cumulative number of re-hospitalizations for the control group was higher (0.9 ± 0.93) than intervention (0.3 ± 0.61) group. Despite the small sample size and limitations of feasibility/pilot studies, our outcomes data appeared to favor the novel intervention. Lessons learned from this study suggest the intervention should be implemented for 6months post-hospital discharge. Further research is needed including large and rigorous multi-center RCTs to generate knowledge explaining the mechanism of the effect of self-management on LVAD treatment outcomes.

Palliative care in patients with left ventricular assist devices: systematic review

HintergrundBei terminal herzinsuffizienten Patienten gewinnt die Implantation von Linksherzunterstützungssystemen (LVAD) als Therapieoption zunehmend an Bedeutung. Diese Systeme werden als Überbrückung bis zu einer Herztransplantation (BTT) oder als definitive Therapie (DT) eingesetzt. Sie können die Lebensqualität verbessern und die Lebenszeit verlängern. Trotzdem bleibt die Prognose besonders bei DT oder bei Wechsel von BTT zu DT mit Blick auf die Lebenszeit und auftretende Komplikationen ungünstig. Bisher ist ungeklärt, ob eine LVAD-Implantation eine Indikation für eine frühzeitige Integration von Palliativmedizin darstellt.Ziel der ArbeitErfassung der aktuellen Studienlage über den Einfluss einer palliativmedizinischen Behandlung bei LVAD-Patienten.Material und MethodenIm Mai 2020 wurde eine systematische Literaturrecherche in 6 verschiedenen Datenbanken durchgeführt.ErgebnisseVon den 491 Treffern der Literaturrecherche wurden 21 Arbeiten in diese Übersichtsarbeit eingeschlossen. Durch die frühzeitige Integration der Palliativmedizin vor LVAD-Implantation erhöhte sich die Anzahl der Patienten mit vorausschauender Versorgungsplanung und Vorsorgeinstrumenten. Außerdem zeigte sich ein positiver Einfluss auf das familiäre Umfeld, das Symptommanagement und die Umstände des Versterbens. Es gibt verschiedene Formate für die Integration palliativmedizinischer Konzepte in die LVAD-Therapie.DiskussionDie frühzeitige und kontinuierliche Einbindung der Palliativmedizin im Verlauf einer LVAD-Therapie kann die Behandlungsqualität verbessern. Die Ausarbeitung von spezifischen Handlungsempfehlungen ist in Abhängigkeit vom Therapieziel (BTT oder DT) sinnvoll. Empfohlen werden Schulungen für Palliativmediziner und LVAD-Spezialisten.

Associations of Gene Polymorphism in Kazakhstani Patients with Implanted LVAD

Purpose Heart failure is one of the main problem in the health care system. The best option of the treatment is heart transplantation (HT). Left ventricular assist device (LVAD) implantation is the best option of alternative treatment instead of HT. Outcome of the LVAD treatment is usually followed with side effects of bleeding and thrombosis. To reduce side effects patients are prescribed with antithrombotic therapy warfarin, which can be followed with side effects because of incorrect individual dosage. Warfarin dosage can be identified according to the results of genetic polymorphisms CYP2C9 and VKORC1. The study is aimed to identify genetic associations of SNP polymorphisms rs1799853, 1057910, rs9923231. Methods Venous blood samples were recruited from 98 patients with implanted LVAD at the National Research Center for Cardiac Surgery. Heart failure patients contained 92 males and 6 females (52.7±10.95 years old) with implanted LVAD devices. The control group contains ninety-five (n=95) conditionally healthy individuals. Warfarin treatment was prescribed after LVAD implantation monthly (after 1st month, 3rd, 6th, 9th and after 1 year etc). SNP polymorphisms were genotyped in case and control groups by real-time polymerase chain reaction with TaqMan probes. Results Genotyping test results were not statistically significant. Case and control groups did not have mutant type of genotypes TT (rs1799853) and CC (rs1057910). Genotype frequency of CC genotype rs1799853 was slightly higher in the case group (92.9% vs.92.6%, p = 1.000). The second SNP rs1057910 had higher frequency of AA genotypes in case group (92.9% vs. 86.3%, p = 0.161). Mutant genotype TT of rs9923231 was slightly higher in the control group (37.9% vs.36.7%, p = 0.718). Monthly clinical dosage of warfarin was compared between three genotypes of rs9923231. Warfarin dosage was significantly associated between three genotypes (p Conclusion Research need to include other polymorphisms for deeper research about individual warfarin dosage and their associations with side effects.

Disparity in Use of Left Ventricular Assist Devices among African American Patients with Medicare

Purpose Heart failure (HF) disproportionally affects racial minorities and disparities in access to therapies exist. Recent work suggests greater use of left ventricular assist devices (LVAD) among African American (AA) patients compared to white patients that likely remains disparate due to a higher prevalence of HF in AA. We sought to understand disparities in LVAD use by race among a cohort of patients with similar HF severity and explore the impact of socioeconomic disadvantage. Methods We analyzed fee-for-service Medicare claims among 311,265 beneficiaries admitted with a principal diagnosis of systolic HF between 2008-2014. Inpatient and outpatient claims in prior 6 months used to estimate propensity for LVAD treatment using synthetic minority over-sampling, a machine learning method. Beneficiaries with ≥70% predicted probability of receiving an LVAD were included. These results were applied to model disparities using logistic regression with LVAD use and 1-year survival with and without LVAD among AA and white recipients as the dependent variables. Model covariates included race, clinical characteristics, distance from LVAD center, and year. After confirming a disparity, the Medicare low-income subsidy included to explore impact of socioeconomic disadvantage. Results The sample included 15,406 observations, of whom 45.2% (n=6,967) received an LVAD. AA were 23.6% (n=3,648) of the population and 21.8% (n=1,520) of LVAD recipients. One-year survival was 73% with LVAD and 62% without. Compared to white patients, AA patients matched for the propensity to receive an LVAD were 4.0% less likely to receive the therapy (95% CI -5.1 to -1.7; p Conclusion Disparities in the use of LVAD for AA Medicare beneficiaries with HF exist that are not entirely explained by socioeconomic disadvantage. These data suggest that other factors are impacting the application of LVAD therapy in AA patients. Potential explanations include racial biases or systemic racism that influence clinician decision-making or patient preferences.

Outcomes Among Patients With Left Ventricular Assist Devices Receiving Maintenance Outpatient Hemodialysis: A Case Series

The incidence of left ventricular assist device (LVAD) implantation as destination therapy for heart failure is increasing and kidney failure requiring maintenance hemodialysis is a common complication. Because little is known about the safety or efficacy of outpatient hemodialysis among patients with LVADs, this study sought to describe their clinical course. Case series of patients with an LVAD undergoing maintenance outpatient hemodialysis whose clinical data were obtained from an electronic medical record. Adults who received an LVAD, survived to hospital discharge, and were subsequently treated with maintenance hemodialysis by a not-for-profit dialysis provider between 2011 and2019. 11 patients were included. 6 had a known history of chronic kidney disease. Patients underwent outpatient hemodialysis for a mean duration of 165.2 (range, 31-542) days, during which they were treated with 544 total dialysis sessions. 6 of these sessions were stopped early due to dialysis-related adverse events (1.1%). More than 80% of follow-up time was spent out of the hospital; however, 55% of patients were rehospitalized within 1 month of starting outpatient hemodialysis. The most common reason for hospitalization was infection (32%), followed by hypervolemia (14%), and cerebrovascular accident or transient ischemic attack (11%). 4 patients recovered kidney function, 1 underwent combined heart and kidney transplantation, 2 continued treatment, 2 died, and 2 were lost to follow-up. Retrospective design, small number of cases, and lack of complete follow-up data. Approximately half the patients with complete follow-up either recovered kidney function or underwent combined heart and kidney transplantation. This case series demonstrates that outpatient hemodialysis centers, in partnership with LVAD treatment teams, can successfully provide hemodialysis to patients on LVAD support.

PSU20 AN ANALYSIS OF CLAIMS DATA FOR LEFT VENTRICULAR ASSIST DEVICE (LVAD) IN SOUTH KOREA BASED ON THE NATIONWIDE DATA FROM THE HEALTH INSURANCE REVIEW AND ASSESSMENT SERVICES

The purpose of this study is to analyze the status of claims of implanted left ventricular assist device treatment after listing in NHI and to use it as basic data for future policy-making. The National Health Insurance Claims Data (NHICD) for the period 2018–2019. We performed analyses to identify characteristics of age and sickness of subjects, and the costs after listing health insurance were divided by insurance cost, co-payment, and treatment material cost. A total of 62 patients were treated for LVAD for 1 year from September 28, 2018. As of November 2019, 6 patients (9.7%) died among the 62 patients who received procedure, and the patients took about 100 days to die after end of the procedure. The 77.4% (n=48) were accounted for male patients in the total number of subjects. Moreover, Analysis of major illnesses that patients claimed when receiving LVAD, showed that the dilated cardiomyopathy was the highest, followed by 17.7% of unspecified heart failures. In the case of cost, the patient's out-of-pocket were about 7,600 dollars per patient, and the total cost was about 162,000 dollars. The out-of-pocket was accounted for 5 % of total costs. Among them, the cost of the material for treatment was 70%, which cost $ 113,800. As a result of analyzing the claims for one year, 62 patients received the LVAD. The proportion of male patients was significantly higher, indicating that there is a needs for additional management of male patients. Moreover, it was conceivable that the cost burden of patients decreased drastically due to the listing of health insurance. This study has limitations in analyzing health insurance claims data, not real world data, but it is meaningful in that it is first attempt to analyze the claims status of LVAD after the procedure is registered in national health insurance.