Introduction:
After a review of the evidence, our publicly funded cardiology evaluation unit recommended to the Quebec Ministry of Health that use of long-term left ventricular assist devices (LVAD) should be carefully monitored and not limited to bridge-to-transplant patients. Herein, we describe use of LVAD and 1-year results in Quebec compared with the INTERMACS registry.
Methods:
A retrospective review of all pertinent hospital data sources of all LVAD-implanted patients in 20102-12 was performed. Variables, definitions and time points (pre-implant, implant, 1 month, 1 year) were based on the INTERMACS registry and results were compared during the same period. Major clinical outcomes (death, transplant, recovery) and adverse events were determined during 1-year follow up for the entire cohort.
Results:
During 2010-2012, 53 LVADs were implanted in Quebec (3 centers). Patients were mostly male (77 %) with a median age of 57 years (interquartile range, IQR: 50-60); 34% were ≥60 years old compared to 47% in INTERMACS. The proportion of Quebec patients with an INTERMACS profile 1 (critical cardiogenic shock; 13%) and 2 (progressive decline; 40%) were very similar to INTERMACS. However, the proportion with INTERMACS profile 3 (stable, inotrope-dependent) was higher in Quebec (43%) than in INTERMACS (27%); in the latter, more patients had INTERMACS profiles 4 (symptoms at rest) to 7 (NYHA Class III). Forty-nine percent of Quebec patients were not on the transplant list at the time of implantation compared to 75% in INTERMACS. LVAD as destination therapy was much less frequent in Quebec (11%) than in INTERMACS (36%).
After LVAD implantation, median intensive care unit stay was 7 days (IQR: 5-14) and median hospital stay for patients who were discharged on support was 24 days (IQR: 20 - 41).
At 1-year, major clinical outcomes of Quebec patients (alive on support 57%; died on support 17%; transplant 24%; explant 2%) were virtually identical to those in INTERMACS. One-year survival for patients on versus not on the transplant list at the time of implantation was not significantly different (p=0.13). As in INTERMACS patients, the most frequent adverse events in Quebec patients were infection, hemorrhage, arrhythmia and right heart failure.
Conclusion:
In comparison with INTERMACS patients, Quebec LVAD patients are younger but sicker and less likely to be implanted as destination therapy. Despite low volumes, clinical results in Quebec hospitals are very similar to those reported for INTERMACS. Only half of Quebec LVAD patients were on the transplant list at the time of implant. Similar clinical results for patients on and off the transplant list in Quebec support the recommendation that transplant eligibility should not be an essential criterion for selection of patients for LVAD. Continued independent monitoring in collaboration with hospitals will be important to optimize quality of care.
Incidence of Pump Thrombosis in HeartMate II during Destination Therapy