Left ventricular assist device exchanges: A safe and effective strategy in the era of limited organ availability.

Abstract

Background: Ongoing donor-organ shortage has limited transplantation making LVADs an effective alternative therapy for patients with end-stage heart failure. When LVAD-associated complications arise device exchange is a feasible and safe alternative. This study addresses the factors that impact survival post-LVAD exchange.

Methods: Our decoded database was constructed retrospectively. Surgical details, device features, and re-intervention information were studied. The primary outcome was mortality. Kaplan-Meier estimators were used for post-pump exchange survival analysis. Pairwise log-rank tests compare the survivals between different groups within each variable. p-Value <0.05 was considered significant. Backward-stepwise regression was used to construct the multivariable model using a subset of variables, retaining only variables with a p-value <0.1. Hazard ratios, their 95% confidence intervals, and p-values of the significant variables were reported.

Results: Analysis of factors impacting survival post-pump exchange study showed a poor survival probability of only primary midline-sternotomy/redo (p = 0.005). Multivariable analysis showed that bridging with ECMO was protective with a hazard ratio of 0.16 (0.03-0.86, p = 0.03).

Conclusions: The overall survival probability is 50% at 4 years post-pump exchange. This study highlights the differences in post-exchange outcomes depending on the device types and surgical approaches used. LVAD exchange for device-related complications can be performed in high-risk patients as a viable alternative to heart transplantation in the setting of the current heart allocation prioritization systems.