James K. Kirklin, MD, Francis D. Pagani, MD, PhD, Robert L

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Presentation transcript:

Eighth annual INTERMACS report: Special focus on framing the impact of adverse events James K. Kirklin, MD, Francis D. Pagani, MD, PhD, Robert L. Kormos, MD, Lynne W. Stevenson, MD, Elizabeth D. Blume, MD, Susan L. Myers, BBA, QMIS, Marissa A. Miller, DVM, MPH, J. Timothy Baldwin, PhD, James B. Young, MD, David C. Naftel, PhD The Journal of Heart and Lung Transplantation Volume 36, Issue 10, Pages 1080-1086 (October 2017) DOI: 10.1016/j.healun.2017.07.005 Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 1 Summary of INTERMACS implants between June 2006 and December 2016. VAD, ventricular assist device; R, right; L, left; TAH, total artificial heart. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 2 Parametric survival curve and associated hazard function for continuous flow implants including both isolated left ventricular assist devices (LVADs) and biventricular support (BiVAD). The dashed lines indicate 70% confidence limits. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 3 Kaplan-Meier survival following continuous flow ventricular assist device implant, stratified by era at the time of implant. LVAD, left ventricular assist device; BiVAD, biventricular assist device. *One patient was implanted with a continuous flow device before 2008 and was excluded from this depiction. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 4 Actuarial survival stratified by whether the ventricular assist device implant represented the original operation, the second operation (first pump replacement), or the third operation (second pump replacement). LVAD, left ventricular assist device; BiVAD, biventricular assist device. Depiction is as in Figure 3. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 5 Competing outcomes depiction for continuous flow left ventricular assist devices (CFLVADs) in patients who are listed for heart transplantation (bridge-to-transplant [BTT]). At any point in time, the sum of the proportions for each outcome equals 1. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 6 Hazard function curves indicating instantaneous risk of death over time for the major causes/modes of death. LVAD, left ventricular assist device; BiVAD, biventricular assist device; RHF, right heart failure; MSOF, multiple system organ failure. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 7 Cumulative hazard function for major causes/modes of death. LVAD, left ventricular assist device; BiVAD, biventricular assist device; RHF, right heart failure; MSOF, multiple system organ failure. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 8 Kaplan-Meier survival curves, stratified by INTERMACS profile at the time of implant. Depiction is as in Figure 3. LVAD, left ventricular assist device; BiVAD, biventricular assist device. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 9 Kaplan-Meier survival curves, stratified by device strategy and era. Depiction is as in Figure 3. LVAD, left ventricular assist device; BiVAD, biventricular assist device. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 10 Kaplan-Meier survival curves, stratified by era and biventricular support (CFBiVAD) vs total artificial heart (TAH). The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 11 Freedom from severe right heart failure (RHF) (Kaplan-Meier), stratified by INTERMACS profile at implant. RVAD, right ventricular assist device; LVAD, left ventricular assist device; BiVAD, biventricular assist device. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 12 Freedom from pump-related infection (PRI), stratified by INTERMACS profile. The depiction is as in Figure 11. CF-LVAD, continuous flow left ventricular assist device; BiVAD, biventricular assist device. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 13 Freedom from first stroke, stratified by INTERMACS profile. The depiction is as in Figure 11. CF-LVAD, continuous flow left ventricular assist device; BiVAD, biventricular assist device. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 14 Freedom from first readmission, stratified by INTERMACS profile. The depiction is as in Figure 11. CF-LVAD, continuous flow left ventricular assist device; BiVAD, biventricular assist device. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 15 Freedom from the combined major event of first infection, bleeding, device malfunction, stroke, or death. The depiction is as in Figure 11. CF-LVAD, continuous flow left ventricular assist device; BiVAD, biventricular assist device. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 16 Solution to the multivariable equation for risk of death after 3 months, conditional on 3-month survival. The dashed lines indicate the 70% confidence limits. LVAD, left ventricular assist device; BiVAD, biventricular assist device. The Journal of Heart and Lung Transplantation 2017 36, 1080-1086DOI: (10.1016/j.healun.2017.07.005) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions