Days Alive and Out of Hospital after Left Ventricular Assist Device Implantation

Background: The use of left ventricular assist devices (LVAD) as bridge to transplant or destination therapy is increasing. Selection of suitable patients is one of the key challenges. Mortality has been traditionally in the focus of research in this field, but literature on factors influencing patients’ life is very limited. Days alive and out of hospital (DAOH) is a potentially useful quality measure that has been suggested to quantify life impact. This study aimed to identify perioperative factors influencing patients’ life as measured by DAOH in the first year after LVAD implantation.

Method: This retrospective single-center cohort study included consecutive patients aged ≥ 18 years who received LVAD implantation between 2010 and 2020. The primary endpoint of this study was DAOH at 1 year after LVAD implantation. First, influence of 10 prespecified variables on DAOH was investigated by univariate analysis. Second, multivariate quantile regression was conducted including all factors with significant influence on DAOH in the univariate model. Additionally, influence of all variables on 1-year mortality was investigated using Kaplan–Meier curves to oppose DAOH and mortality.

Results: In total, 227 patients were included into the study (86.4% male, mean age 58 ± 11 years). Six patients (2.6%) had to be excluded due to incomplete medical records so that 221 patients remained for statistical analysis. Median DAOH in the whole cohort was 273 days (interquartile range: 67–321). Overall, 1-year mortality was 24.9%. Preoperative INTERMACS profile, preexisting chronic kidney disease, use of right ventricular assist device, postoperative dialysis and postoperative tracheotomy could be identified as independent factors associated with reduced DAOH. Age greater/equal to 65 years, underlying disease, preoperative mechanical circulatory support, surgical approach and preoperative levosimendan therapy revealed no significant impact on DAOH after LVAD. According to Kaplan–Meier analysis, only postoperative dialysis was significantly associated with increased mortality at 1 year.

Conclusion: As a more patient centered outcome reflecting life-impact, DAOH may relevantly contribute to a more comprehensive assessment of outcome in LVAD patients. The results of this study may help to guide clinicians that are integrated into the challenging selection process of patients suitable for LVAD implantation.