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Original Articles

Impact of Center Volume on Outcomes of Left Ventricular Assist Device Implantation as Destination Therapy

Analysis of the Thoratec HeartMate Registry, 1998 to 2005

Katherine Lietz, MD, PhD; James W. Long, MD, PhD; Abdallah G. Kfoury, MD; Mark S. Slaughter, MD; Marc A. Silver, MD; Carmelo A. Milano, MD; Joseph G. Rogers, MD; Leslie W. Miller, MD; Mario Deng, MD; Yoshifumi Naka, MD, PhD and Donna Mancini, MD

From the Cardiovascular and Cardiothoracic Divisions of Columbia University Medical Center (K.L., M.D., Y.N., D.M.), New York, NY; Intermountain Medical Center (J.L., A.G.K.), Salt Late City, Utah; Advocate Christ Medical Center (M.S.S., M.A.S.), Oak Lawn, Ill; Duke University Medical Center (C.A.M., J.G.R.), Durham, NC; and Georgetown University-Washington Hospital Center (L.W.M.), Washington, DC.

Correspondence to Katherine Lietz, MD, PhD, Center for Advanced Cardiac Care, Columbia-Presbyterian Medical Center, PH12 Stem Rm 134, 622W 168th St, New York, NY 10032. E-mail KL2384{at}columbia.edu

Received March 11, 2008; accepted November 18, 2008.

Background— More than 400 patients with end-stage heart failure underwent left ventricular assist device (LVAD) implantation of LVAD as destination therapy (DT) after the US Food and Drug Administration approval of DT in 2002. Because most of these patients had surgeries at hospitals that were newly accredited, we sought to examine the impact of LVAD center volume on the outcomes of DT.

Methods and Results— From July 1998 through December 2005, a total of 377 patients underwent implantation of HeartMate I LVAD as DT at 68 centers in the United States. Using data from the Thoratec DT Registry, we examined the association between LVAD center volume at the time of surgery and 1-year survival with DT. Of the studied 377 DT recipients, 53% underwent device implantation at centers that performed 4 DT implants at the time of surgery. Center experience with DT seemed to significantly correlate with the 1-year survival (47.8% versus 67.4% in recipients of 4th DT versus >9th DT implant; P=0.009). However, the DT center volume was not an independent predictor of 1-year survival with DT when adjusted for the preoperative DT Risk Score, suggesting that other factors, such as improved candidate selection, may have accounted for the institutional learning curve.

Conclusions— The institutional experience with DT may have a significant impact on outcomes of this therapy. Better selection of candidates, systemic approach to surgical and postoperative care, as well as the long-term medical management most likely all contribute to these improvements.

Key Words: center volume • destination therapy • left ventricular assist devices

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CLINICAL PERSPECTIVE

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Innovation With Experience Using Implantable Left Ventricular Assist Devices

Deborah D. Ascheim, Annetine C. Gelijns, and Eric A. Rose
Circ Heart Fail 2009 2: 1-2. [Extract] [Full Text] [PDF]

Impact of Center Volume on Outcomes of Left Ventricular Assist Device Implantation as Destination Therapy: Analysis of the Thoratec HeartMate Registry, 1998 to 2005

Katherine Lietz, James W. Long, Abdallah G. Kfoury, Mark S. Slaughter, Marc A. Silver, Carmelo A. Milano, Joseph G. Rogers, Leslie W. Miller, Mario Deng, Yoshifumi Naka, and Donna Mancini
Circ Heart Fail 2009 2: 3-10. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				D. D. Ascheim, A. C. Gelijns, and E. A. Rose Innovation With Experience Using Implantable Left Ventricular Assist Devices Circ Heart Fail, January 1, 2009; 2(1): 1 - 2. [Full Text] [PDF]