Document Detail


Mechanical circulatory support for advanced heart failure: effect of patient selection on outcome.
MedLine Citation:
PMID:  11208682     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
M C Deng; M Loebe; A El-Banayosy; E Gronda; P G Jansen; M Vigano; G M Wieselthaler; B Reichart; E Vitali; A Pavie; T Mesana; D Y Loisance; D R Wheeldon; P M Portner
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  103     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  2001 Jan 
Date Detail:
Created Date:  2004-07-08     Completed Date:  2004-07-29     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  231-7     Citation Subset:  AIM; IM    
Affiliation:
Cardiothoracic Surgery and Transplant Center, Westfalian Wilhelms University Münster, Münster, Germany. md785@columbia.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Cardiac Output, Low / mortality,  physiopathology*,  surgery*
Cohort Studies
Equipment Design
Female
Heart-Assist Devices*
Humans
Male
Middle Aged
Multivariate Analysis
Outpatients / statistics & numerical data
Patient Selection*
Prognosis
Risk Factors
Severity of Illness Index
Survival Analysis
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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