Can long-term ventricular assist devices be safely implanted in low-volume, non-heart transplant centres?

Background: Mechanical circulatory support (MCS) using long-term ventricular assist devices (VADs) is an established therapy in select patients with advanced heart failure. Studies have suggested that outcomes after VAD implantation may be dependent on institutional procedural volume, and outcome data from non-transplant centres are lacking. This study reviews the outcomes of patients who received a long-term VAD at our centre to determine if these devices can be safely implanted at tertiary care, low-volume, non-transplant centres.

Methods: We conducted a single-centre retrospective cohort study, examining the clinical outcomes of consecutive patients who received a long-term VAD over a 42-month period.

Results: During the study period 73 patients required MCS, of whom 16 received a long-term VAD. This select group had a mean Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile of 1.6 (0.9) and before implantation 94% required at least 1 inotropic medication, 69% had suffered a cardiac arrest, 63% required an intra-aortic balloon pump, 69% required mechanical ventilation, and 44% required short-term MCS. The primary outcome of survival to transplant or ongoing MCS at 1 year was achieved in 75% of patients. Operating room, intensive care unit, and hospital survival were 100%, 88%, and 81%, respectively.

Conclusions: Long-term VADs can be implanted at low-volume, nontransplant centres with survival rates comparable with contemporary clinical trials. Availability of a specialty trained multidisciplinary team with expertise in short-term and long-term MCS options facilitates appropriate patient selection and might be more important than institutional volume in determining outcomes after implantation.