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Late Complications Associated with Destination Therapy Support for Continuous Flow Left Ventricular Assist Devices in the Modern Era
Nadia H. Bakir, Michael J. Finnan, Joel D. Schilling, Gregory A. Ewald, Kunal D. Kotkar, Akinobu Itoh, Marc R. Moon, Muhammad F. Masood.
Washington University School of Medicine, St. Louis, MO, USA.

OBJECTIVE: Patients supported by continuous flow left ventricular assist device(CF-LVAD) as destination therapy(DT) are often supported for longer than patients bridged to transplant, so they are uniquely susceptible to complications. This study utilized a competing risks model to evaluate the most common device-related complications in a cohort of DT patients from a single center.
METHODS: All patients implanted with a DT indication for CF-LVAD at our institution between June 2008 and April 2020 were retrospectively reviewed. A competing risks model with Fine-Gray regression was used to evaluate major complications as a composite of gastrointestinal bleeding, stroke, and infection.
RESULTS: Patients implanted with CF-LVAD(n=319) were stratified by device type into HeartMate II(n=205), HeartMate III(n=72), and HVAD groups(n=42).Overall survival free from any complication was 36% and 8% at the same time points(Figure). Strokes were classified as either hemorrhagic(39/71; 55%) or embolic(32/71; 45%). Episodes of GI bleed required a median of 3[2,5]units of packed red blood cells. The majority of infections(67/118, 57%) were gram positive. The remainder were either gram negative(18/118, 15%) or polymicrobial(33/118, 28%). Of the patients who experienced a driveline infection, 23%(27/118) developed sepsis. Notable predictors for the development of complications included African American race (SHR 1.75(1.28-2.38), P<0.001) and devices other than Heartmate III (SHR 0.68(0.49-0.95), P=0.024).
CONCLUSIONS: The burden of device related complications remains high among DT patients. While Heartmate III had a significantly lower burden of complications, clinicians should also consider variables such as diabetes, African American race, age, and prior LVAD when selecting and monitoring patients.


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