Features for Success: Factors Associated with Successful LVAD Outcomes at 1-Year Post Implant

Abstract

Purpose As quality and duration of life support continues to improve in patients with end stage HF post LVAD the perception of what defines a ‘successful’ LVAD implant is debatable. We sought to assess success for patients undergoing LVAD implant and defining pre-operative variables that would predict such an outcome at 1-year post implant. Methods Using the INTERMACs registry data between 2012-2015 (n= 13,162) we identified patients with successful outcomes. This was defined as meeting all 4 criteria: alive or transplanted at 1-year post implant, having an NYHA class of I or II at 6 months post implant, having no adverse events (gastrointestinal bleeding, infection, stroke, or pump thrombosis), and having 2 or fewer hospitalizations within the first year. We compared the ‘successful’ and ‘unsuccessful’ patient populations to identify key differentiating features in their pre-op data. We used backward logistic regression to identify variables that were predictive of the successful LVAD outcome. Results Out of 13,162 CF-LVAD patients, 3008 (28%) were considered ‘successful’ (Table 1). The logistic regression model kept the following variables, as predictors of a 1-year successful outcome: BTT device strategy, no of previous cardiac operations, low INTERMACS profile, no RVAD at time of LVAD implant, low creatinine , low volume at implant center, lower age, and higher hemoglobin. Conclusion Under one third of all patients receiving an LVAD have a successful 1-year outcome. While most indicators for success are non-modifiable patient features, identification of patients at high risk of ‘unsuccessful’ LVAD implant may inform patient management.