![]() Patients with LVADs require antiplatelet and anticoagulant therapy, which predisposes them to bleeding complications. Bleeding that occurs in the first 14 days after the implantation is mostly related to surgery. Bleeding complicationsīleeding is the most common adverse event after LVAD implantation. With regard to timing, complications after LVAD placement can be early (less than 30 days after placement], or late (occurring more than 30 days after placement). Major, non-surgical, adverse events and complications with the LVAD include bleeding complications, device thrombosis, ischaemic and haemorrhagic strokes, renal impairment, multi-organ failure and infections, which have been the primary causes of death in some series. The median time to readmission was 35 days after an initial discharge. It has been shown that patients were readmitted, on average, 2.2 times during their 11-month median follow-up time. Unplanned hospital readmissions are common. ![]() LVAD-related complications can occur in up to 60% of patients by six months post-implantation, and, by two years, 80% of patients experience at least one adverse event. However, with the increasing usage of LVADs and longer survival, a substantial number of patients experience adverse events and complications. The transition from pulsatile to CF-LVADs has been associated with a significant decline in overall rates of adverse events, improved durability and much better long-term survival for both the BTT and DT indications. Continuous-flow LVADs (CF-LVAD) have accounted for virtually 100% of devices in patients receiving DT since 2010 and actuarial survival is currently 81% at one year, 70% at two years, 60% at three years, and 48% at four years. The number of implanted LVADs is now approaching the number of heart transplantations performed in the USA (1]. The median time of support in patients awaiting heart transplantation is around 300 days (IQR, 147-537 days). The use of LVADs as a DT has increased in past years and currently represents approximately 46% of all LVAD placements so people are on LVAD support for longer durations. In the USA, the HeartMate II has been approved for BTT since 2008 and as a DT since 2010, while the HeartWare has been approved as a BTT since 2010 and is still awaiting approval for DT. In Europe, the HeartMate II was authorised for BTT and for DT in November 2005, while the HeartWare received approval for use in patients as a BTT in 2009 and as a DT in 2012. The two leading LVAD devices currently on the market are the axial continuous-flow HeartMate II (Thoratec Corp., Pleasanton, CA, USA) and the centrifugal continuous-flow HeartWare (HeartWare International, Inc., Framingham, MA, USA). The use of a left ventricular assist device (LVAD), as a bridge to heart transplant (BTT), as a destination therapy (DT), or as a “bridge to recovery”, has become an important option for the treatment of patients with advanced heart failure refractory to medical therapy. INTERMACS: Interagency Registry for Mechanically Assisted Circulatory Support AUS: anaemia of undetermined source of bleedingĬF-LVAD: continuous flow left ventricular assist device
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