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Original research article
Patient survival and therapeutic outcome in the UK bridge to transplant left ventricular assist device population
  1. Jayan Parameshwar1,
  2. Rachel Hogg2,
  3. Sally Rushton2,
  4. Rhiannon Taylor2,
  5. Steven Shaw3,
  6. Jenny Mehew2,
  7. Andre Simon4,
  8. Guy A MacGowan5,
  9. Jonathan R Dalzell6,
  10. Nawwar Al Attar6,
  11. Rajamiyer Venkateswaran3,
  12. Hoong Sern Lim7,
  13. Stephan Schueler5,
  14. Steven Tsui1,
  15. Nicholas Robert Banner4
  1. 1 Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
  2. 2 Statistics and Clinical Studies, NHS Blood and Transplant, Bristol, UK
  3. 3 Manchester University Foundation Trust, Wythenshaw Hospital, Manchester, UK
  4. 4 Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
  5. 5 The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
  6. 6 Golden Jubilee National Hospital, Glasgow, UK
  7. 7 University of Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Jayan Parameshwar, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB23 3RE, UK; j.parameshwar{at}nhs.net

Abstract

Objective To study the survival and patient outcome in a population of UK patients supported by an implantable left ventricular assist device (LVAD) as a bridge to heart transplantation.

Methods Data on all adult patients (n=342) who received a HeartMate II or HVAD as a first long-term LVAD between January 2007 and 31 December 2013 were extracted from the UK Ventricular Assist Device (VAD) Database in November 2015. Outcomes analysed include survival on a LVAD, time to urgent listing, heart transplantation and complications including those needing a pump exchange.

Results 112 patients were supported with the Thoratec HeartMate II and 230 were supported with the HeartWare HVAD. Median duration of support was 534 days. During the study period, 81 patients required moving to the UK urgent waiting list for heart transplantation. Of the 342 patients, 85 (24.8%) received a heart transplant, this included 63 on the urgent list. Thirty-day survival was 88.9%, while overall patient survival at 3 years from LVAD implant was 49.6%. 156 patients (46%) died during LVAD support; the most common cause of death on a VAD was a cerebrovascular accident. There was no significant difference between the two devices used in any outcome.

Conclusions In a population of patients with advanced heart failure, who have a very poor prognosis, support with an implantable LVAD allowed a quarter to receive a heart transplant in a 3-year period. Overall survival of the cohort was about 50%. With improvement in technology and in post-LVAD management, it is likely that outcomes will improve further.

  • advanced heart failure therapies (LV assist devices, total artificial heart)
  • heart transplantation

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Footnotes

  • Contributors All the authors were involved in planning the study. All participated in meetings reviewing the data and read and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ST: Proctor and Investigator for Medtronic (HeartWare); RV: Proctor and Consultant for Abbott (Thoratec), SSh: Proctor and Consultant for Medtronic (HeartWare), AS: Consultant for Medtronic (HeartWare), SSc: Consultant for Abbott (Thoratec).

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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