Left ventricular assist devices for treatment of refractory advanced heart failure: the Western Australian experience

Abstract

AbstractBackgroundLeft ventricular (LV) assist devices (LVADs) can prolong survival and improve quality of life in end‐stage heart failure.AimsReview outcomes of the Western Australian LVAD programme.MethodsRetrospective database and medical record review.ResultsOne hundred forty‐seven LVADs have been implanted in 23 years, of which 95 were newer‐generation devices (HeartWare HVAD [HW], HeartMate II and HeartMate 3). Presented data refer to these devices only. Most patients (94%) were classed as bridge‐to‐transplant or ‐candidacy/decision, with the remainder classed as ‘destination therapy’ (DT). Mean LV ejection fraction was 20%, and 36% had severe right ventricular dysfunction. Sixty‐two percent of patients had a nonischaemic cardiomyopathy. Following LVAD implant, the median length of stay in intensive care was 2 days, and in the hospital overall was 23 days. Ninety‐six percent of patients survived to hospital discharge, and, following discharge, 98% of days with LVAD were spent as an outpatient. The median number of hospital readmissions was 1.5 per patient per year. LVAD‐associated infection requiring admission or intravenous antibiotics at any time after implant occurred in 36%, significant gastrointestinal bleeding in 19% and stroke in 11%. The percentage of patients alive with LVAD still in situ at 1, 2 and 5 years was 94%, 88% and 62% respectively, which exceeds current international registry outcomes. All DT patients survived at least 4 years, spending 97% of days with LVAD as an outpatient. The two longest‐surviving HW DT patients worldwide (11.3 and 10.5 years) are among this cohort.ConclusionsExcellent outcomes can be achieved with LVADs in appropriately selected patients.