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OBJECTIVE:
No clinical study compares outcomes of left ventricular assist device (LVAD) implantation in patients with end-stage heart failure secondary to ischemic cardiomyopathy (ICM) & non-ischemic cardiomyopathy (NICM). Purpose of this study is to analyze the outcome of LVAD therapy in these 2 cohorts of patients.
METHODS:
44 patients had Heartmate 2 LVAD implantation between September 2009 & August 2011. Charts were retrospectively reviewed & data accumulated was statistically analysed.
RESULTS:
23 (52%) presented with ICM. Average age in ICM was 63.7 ± 6.8 years as opposed to 53.9 ±16.3 in NICM (p= 0.017). 78% of ICM & 67% of NICM group were male (p=NS). 43.5% of ICM had undergone previous cardiac operation vs 9.5% of NICM (p=0.012). Implant strategy was bridge to transplant in 78% of ICM & 67% of NICM (p=NS); and destination therapy in 22% of ICM & 33% of NICM (p=NS). 30-day mortality rate was 17% in the ICM & 0% in the NICM (p =0.06). 1 year mortality was 39% for ICM and 19% for NICM (p=0.14). On multivariate analysis, ICM emerged as an independent predictor of mortality (OR: 3.19). Variables such as serum creatinine, inotropic or vasopressor requirement, IABP use or complex operations involving aortic or tricuspid valves at the time of LVAD placement did not impact mortality.
CONCLUSIONS:
This report, based on a non-matched cohort of 44 patients, demonstrates that in an era of selective criteria for LVAD implantation, ICM emerges as an independent predictor of mortality. These patients tend to be older, & are more likely to be undergoing re-operative sternotomy. These results should form the basis for a larger scale investigation of LVAD implantation in ICM patients.