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Quality of life and functional status in patients surviving 12 months after left ventricular assist device implantation.

Authors
  • Allen, Jeremiah G1
  • Weiss, Eric S
  • Schaffer, Justin M
  • Patel, Nishant D
  • Ullrich, Susan L
  • Russell, Stuart D
  • Shah, Ashish S
  • Conte, John V
  • 1 Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University Medical Institutions, Baltimore, Maryland 21287, USA.
Type
Published Article
Journal
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
Publication Date
Mar 01, 2010
Volume
29
Issue
3
Pages
278–285
Identifiers
DOI: 10.1016/j.healun.2009.07.017
PMID: 19837607
Source
Medline
Language
English
License
Unknown

Abstract

As left ventricular assist device (LVAD) support duration increases, quality of life (QoL) becomes a concern. We reviewed the QoL in patients on LVAD support for >or=1 year. We retrospectively reviewed our prospective database for patients supported >or=1 year by HeartMate pulsatile- (HM1) or continuous-flow (HM2) LVADs from 2000 to 2009. Transplant or death before 1 year merited exclusion. Metabolic equivalents of tasks (METs), the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the 6-minute walk distance (6MWD), and New York Heart Association (NYHA) class were reviewed. Complications and re-admissions were assessed. Thirty patients were supported for >or=1 year (7 HM1s, 23 HM2s). Mean support duration was 594 +/- 173 days. Mean QoL metrics/functional status indicators at 12 months were: 6MWD, 393 +/- 290 m; MET tolerance, 3.3 +/- 1; MLHFQ, 35 +/- 31; and NYHA, 1.4 +/- 0.6. Mean re-admissions/year was 2.9 +/- 2, with a duration of 13.8 +/- 21 days. Three patients were never re-admitted. Mean out-of-hospital time was 471 +/- 172 days (87.3% of days). Infectious complications led to 43% of re-admissions and occurred in the: drive-line (47%) at 442 +/- 236 days; blood (37%) at 472 +/- 257 days; and LVAD pocket (20%) at 550 +/- 202 days. Twenty-three patients (77%) required additional operations (1.7 +/- 1.8/year). The most common indication was drive-line infection, but ranged from ischemic bowel to defibrillator exchange. Eight required LVAD exchanges for mechanical (n = 4), electrical (n = 3), and thrombotic (n = 1) issues. Although LVAD support is not without complications, patients spend the majority of time outside the hospital enjoying a good quality of life.

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