Outcomes after implantation of left ventricular assist devices in patients with terminal heart failure complicated by cardiogenic shock at time of device placement

Aims: Presence of cardiogenic shock at time of left ventricular assist device (LVAD) placement for treatment of terminal heart failure diminishes the therapy success. We studied the impact of cardiogenic shock on survival in recipients of new miniaturized rotary blood pumps.

Methods: Between 08/2009 and 07/2011 a total of 116 patients with terminal heart failure were treated with the centrifugal blood pump HeartWare HVAD. We divided patients as follows: Group 1, those suffering from cardiogenic shock (defined according INTERMACS level 1: persistent hypotension despite rapidly escalating inotropic support and eventually IABP, and critical organ hypoperfusion), n=22; Group 2, those without shock at time of device placement, n=96. Survival rate and clinical course in both groups were analyzed.

Results: Cumulative survival rate at 90 days and 1 year was 86% for group 1 and 83% and 81% for group 2, respectively (p=0.7). In Group 1 median support time and cumulative follow-up were 215 days (range 6–665 days) and 15.5 pt./y., with 14 patients with ongoing support and 2 transplanted compared to those in group 2: 234 days (range 1–682 days) and 64.4 pt./y., with 65 patients with ongoing support, 3 transplanted and 1 weaned from the device.

Conclusion: A HeartWare HVAD provides good hemodynamic support and end-organ recovery in heart failure patients with and without signs of cardiogenic shock at time of device insertion.

After hospital discharge both groups presented good outcomes of long-term circulatory support.