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Improved survival in patients with ventricular assist device therapy: the University of Wisconsin experience

^a Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
^b Heart Failure and Transplant Cardiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States

Received 5 October 2007; received in revised form 17 April 2008; accepted 21 April 2008.

^_* Corresponding author. Address: Department of Surgery, Division of Cardiovascular Surgery, University of Wisconsin School of Medicine and Public Health, H4/337 Clinical Science Center 600 Highland Avenue, Madison, WI 53792-3236, United States. Tel.: +1 608 263 4071; fax: +1 608 263 0547. (Email: osaki{at}surgery.wisc.edu).

Objective: Ventricular assist devices (VADs) have been implanted since 1990 in our institution, becoming an increasingly common treatment for end-stage heart failure. Beginning in 1997, VAD patients were discharged home when feasible. In August 2003, a dedicated multidisciplinary VAD team (cardiac surgeons, cardiologists, VAD coordinators, nurses, rehabilitation specialists, nutrition experts, psychologists, pharmacists, social workers, and administrators) was created to optimize the management of VAD patients. The purpose of this study is to analyze the impact of these changes in care at our center over the last 17 years. Methods: We retrospectively studied 107 consecutive VAD recipients between June 1990 and August 2006. VADs were implanted as bridge to recovery, bridge to transplant and destination therapy. The cohort was divided by care plans into early (n = 37, June 1990–1996), mid (n = 32, 1997–July 2003), and late groups (n = 38, August 2003–August 2006). Demographic profile, survival and complications were assessed. Results: Patient demographics tended to show an increased severity of illness over time. Post-VAD survival rate significantly improved in the late group (post-VAD 1- and 3-year survival rates; early: 54.1% and 40.5%; mid: 51.6% and 41.9%; late: 86.8% and 82.5%, p < 0.001, respectively). The incidence of complications including re-operation, major bleeding and major infection, significantly decreased in the late group (p < 0.05). Conclusions: Outcomes have improved dramatically in recent VAD patients, despite an increasingly high-risk patient population. These data suggest that advances in device technology and medical therapies, as well as a multidisciplinary approach, have improved survival on VAD therapy.

Key Words: Mechanical circulatory support • Ventricular assist device • Congestive heart failure