Mechanical Circulatory Support for Advanced Heart Failure: Effect of Patient Selection on Outcome

Mario C Deng; Matthias Loebe; Aly El-Banayosy; Edoardo Gronda; Piet G. M Jansen; Mario Vigano; Georg M Wieselthaler; Bruno Reichart; Ettore Vitali; Alain Pavie; Thierry Mesana; Daniel Y Loisance; Dereck R Wheeldon; Peer M Portner

doi:10.1161/01.CIR.103.2.231

Journal article

Mechanical Circulatory Support for Advanced Heart Failure: Effect of Patient Selection on Outcome

Mario C Deng, Matthias Loebe, Aly El-Banayosy, Edoardo Gronda, Piet G. M Jansen, Mario Vigano, Georg M Wieselthaler, Bruno Reichart, Ettore Vitali, Alain Pavie, …

Circulation (New York, N.Y.), Vol.103(2), pp.231-237

2001-01-16

DOI: https://doi.org/10.1161/01.CIR.103.2.231

PMID: 11208682

Abstract

Background —Use of wearable left ventricular assist systems (LVAS) in the treatment of advanced heart failure has steadily increased since 1993, when these devices became generally available in Europe. The aim of this study was to identify in an unselected cohort of LVAS recipients those aspects of patient selection that have an impact on postimplant survival. Methods and Results —Data were obtained from the Novacor European Registry. Between 1993 and 1999, 464 patients were implanted with the Novacor LVAS. The majority had idiopathic (60%) or ischemic (27%) cardiomyopathy; the median age at implant was 49 (16 to 75) years. The median support time was 100 days (4.1 years maximum). Forty-nine percent of the recipients were discharged from the hospital on LVAS; they spent 75% of their time out of the hospital. For a subset of 366 recipients, for whom a complete set of data was available, multivariate analysis revealed that the following preimplant conditions were independent risk factors for survival after LVAS implantation: respiratory failure associated with septicemia (odds ratio 11.2), right heart failure (odds ratio 3.2), age >65 years (odds ratio 3.01), acute postcardiotomy (odds ratio 1.8), and acute infarction (odds ratio 1.7). For patients without any of these factors, the 1-year survival after LVAS implantation including the posttransplantation period was 60%; for the combined group with at least 1 risk factor, it was 24%. Conclusions —Careful selection, specifically implantation before patients become moribund, and improvement of management may result in improved outcomes of LVAS treatment for advanced heart failure.

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.37 Cardiology - General; 1.37.836 Left Ventricular Assist Device
Web Of Science research areas: Cardiac & Cardiovascular Systems; Peripheral Vascular Disease
ESI research areas: Clinical Medicine

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Title: Mechanical Circulatory Support for Advanced Heart Failure
Creators: Mario C Deng - From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna
Matthias Loebe - From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna
Aly El-Banayosy - From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna
Edoardo Gronda - From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna
Piet G. M Jansen - From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna
Mario Vigano - From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna
Georg M Wieselthaler - From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna
Bruno Reichart - From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna
Ettore Vitali - From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna
Alain Pavie - From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna
Thierry Mesana - From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna
Daniel Y Loisance - From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna
Dereck R Wheeldon - From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna
Peer M Portner - From the Cardiothoracic Surgery and Transplant Center (M.C.D.), Westfalian Wilhelms University Münster, Münster, Germany; the German Heart Institute (M.L.), Berlin, Germany; Heartcenter North Rhine Westfalia (A.E.-B.), Bad Oeynhausen, Germany; Hospital Niguarda Ca’ Granda Milano (E.G., E.V.), Milan, Italy; World Heart Corporation (P.G.M.J., D.R.W.), Oakland, Calif; IRCCS Policlinico S. Matteo (M.V.), University of Pavia, Pavia, Italy; Cardiothoracic Surgery (G.M.W.), University of Vienna, Vienna
Publication Details: Circulation (New York, N.Y.), Vol.103(2), pp.231-237
Academic Unit: Miller School of Medicine; Miami Transplant Institute; UMMG Department of Surgery
Language: English
Resource Type: Journal article
PMID: 11208682
Record Identifier: 991031615201602976