Survival: Survival after LVAD continues to improve due to technological advances. In the 2019 INTERMACS report in the United States of 13,016 FDA-approved LVADs from 2014 to 2018, 1-year survival rate was significantly higher for the newer LVADs with full magnetic levitation (HM 3) versus axial flow (HM 2) (87% vs 79%, P < .001). Most common causes of death are neurologic (19%), multiorgan failure (18%), and right heart failure (10%). Short-term survival for the current generation of LVADs is now approaching that following heart transplant but patient selection is critical. Figure 6.7 shows survival stratified by the INTERMACS profile of patients supported on LVADs.

Morbidity: Despite significant improvements in survival, patients with an LVAD still have complications resulting in recurrent hospitalizations. In a US study of 2,510 LVAD recipients, 31% were hospitalized within 30 days, and 75% due to infection, bleeding, and device-related issues. The Society of Thoracic Surgeons annual report showed 2.18 readmissions per patient at 12 months. The most common complications are drive-line infection, GI bleeding, stroke, and pump thrombosis requiring pump replacement.

Quality of life: Several studies have shown improvement in patient functional capacity and quality-of-life parameters after LVAD at 3 months and continuing to at least 2 years, although some groups such as females and older patients take longer to see these improvements. Examples of improved quality of life include 6-minute walking distance increasing from 136 to 325 m at 12 months for HM 3.

References

• Goldstein DJ, Meyns B, Xie R, et al. Third annual report from the ISHLT mechanically assisted circulatory support registry: a comparison of centrifugal and axial continuous-flow left ventricular assist devices. J Heart Lung Transplant. 2019;38:352-363.
• Kirklin JK, Pagani FD, Kormos RL, et al. Eighth annual INTERMACS report: special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017;36:1080-1086.
• Maciver J, Ross HJ. Quality of life and left ventricular assist device support. Circulation. 2012;126:866-874.
• Mehra MR, Uriel N, Naka Y, et al. A fully magnetically levitated left ventricular assist device—final report. N Engl J Med. 2019;380:1618-1627.