Objectives

The aim of this study was to analyze our 10-year experience with the HVAD® in a real-world scenario in a high-volume German heart center. 

Methods

We retrospectively analyzed outcomes of adults (≥18 years) with terminal heart failure (HF), who underwent HVAD® implantation for durable LVAD therapy in our center between October 2009 and March 2020. Primary and secondary end-point were all-cause death after implantation and LVAD-associated complications, respectively. We focused the distinct analyses on risk profiles at the time of implantation and implant strategies, i.e. bridge-to-transplant (BTT) or destination therapy (DT). 

Results

A total of 510 patients were included, with 229 and 281 individuals in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 1 (45%) and 2-4, respectively. Median follow-up was 26 month (IQR: 5-54 months). Overall survival at 1, 3 and 5 years after HVAD® implantation was 66% (95%CI; 61.7-70%), 49.4% (95%CI; 44.9-53.8%), and 37.4% (95%CI;32.8-42%), not censored for LVAD exchange, LVAD explantation or heart transplantation. INTERMACS level 1 and peri-operative temporary right heart assistance were independent risk factors for survival. Survival was best in BTT patients undergoing heart transplantation at any time during follow-up. The INTERMACS level at time of HVAD® implantation did not affect survival after heart transplantation. Freedom from the combined end-point of any device-associated severe complication and death was 44.5% (95%CI; 40-48.8%) at 1-year after implantation. 

Conclusions