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Continuous-flow LVADs in the Nordic countries: complications and mortality and its predictors
Lund Univ, Dept Clin Sci, Cardiol, Lund, Sweden;Skane Univ Hosp, Lund, Sweden.
Skane Univ Hosp, Lund, Sweden;Lund Univ, Dept Cardiothorac Surg, Cardiothorac Surg, Lund, Sweden.
Rigshosp, Dept Cardiol, Copenhagen, Denmark.
Sahlgrens Univ Hosp, Dept Cardiothorac Surg, Gothenburg, Sweden.
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2019 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 53, no 1, p. 14-20Article in journal (Refereed) Published
Abstract [en]

Objectives: The purpose of this study was to assess complications and mortality and its predictors, with continuous-flow left ventricular assist devices (CF-LVADs) in the Nordic Countries.

Design: This was a retrospective, international, multicenter cohort study.

Results: Between 1993 and 2013, 442 surgically implanted long-term mechanical assist devices were used among 8 centers in the Nordic countries. Of those, 238 were CF-LVADs (HVAD or HeartMate II) implanted in patients >18 years with complete data. Postoperative complications and survival were compared and Cox proportion hazard regression analysis was used to identify predictors of mortality. The overall Kaplan-Meier survival rate was 75% at 1 year, 69% at 2 years and 63% at 3 years. A planned strategy of destination therapy had poorer survival compared to a strategy of bridge to transplantation or decision (2-year survival of 41% vs. 76%, p < .001). The most common complications were non-driveline infections (excluding sepsis) (44%), driveline infection (27%), need for continuous renal replacement therapy (25%) and right heart failure (24%). In a multivariate model age and left ventricular diastolic dimension was left as independent risk factors for mortality with a hazard ratio of 1.35 (95% confidence interval (CI) [1.01-1.80], p = .046) per 10 years and 0.88 (95% CI [0.72-0.99], p = .044) per 5 mm, respectively.

Conclusion: Outcome with CF LVAD in the Nordic countries was comparable to other cohorts. Higher age and destination therapy require particularly stringent selection.

Place, publisher, year, edition, pages
2019. Vol. 53, no 1, p. 14-20
Keywords [en]
Heart failure, mechanical circulatory support, left ventricular assist device, outcomes
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-382365DOI: 10.1080/14017431.2019.1583365ISI: 000463610600002PubMedID: 30776923OAI: oai:DiVA.org:uu-382365DiVA, id: diva2:1307825
Funder
Swedish Heart Lung FoundationThe Crafoord FoundationAvailable from: 2019-04-29 Created: 2019-04-29 Last updated: 2019-04-29Bibliographically approved

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