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Prolonged Circulatory Support (Five Years or Longer) with Left Ventricular Assist Devices for Patients with Advanced Heart Failure
Abstracts S261 Purpose: Many complications in LVAD therapy occur during the post implantation phase. An effective outpatient management including telemonitoring may be one key for improved LVAD therapy outcome, e.g. by reducing the number of postsurgical outpatient visits and by early detection of complications. In patients with chronic cardiac diseases telemedicine is already used and has been shown to reduce mortality. However, in LVAD therapy there is limited knowledge of patient’s acceptance, awareness and need of such future service, which was investigated within this study. Methods: The semi quantitative questionnaire survey (January 2016 - June 2016) includes interviews with 180 VAD patients at two German heart centers (age: 57.14 ± 12.8 yrs, 82.2% male, 1012 ± 693 d on device). Descriptive statistic and analysis of the data was performed using SPSS Statistic Software V23. Results: 76.8% of our patients wish LVAD telemonitoring, although only 30.3% have heard about telemedicine before. Our patients expect a higher quality of life with telemonitoring (62.98 vs 68.85; 0= poor, 100= high; p> 0.001). The desire for telemedicine correlates with the expectation of an increased safety for their therapy (p> 0.001). However, we found a significant difference in the request for telemedicine depending on home situation and support (p < 0.05): 80% of patients who do not live alone and / or have a support in daily life wants LVAD telemonitoring vs to 60% of the patients who live alone and/or have no support at home. Patients who heard about telemedicine before desire future LVAD telemonitoring more often compared to patients who had their first contact with telemedicine within our survey (88.0% vs 73.9%, p< 0.05). Patients report high confidence in telemedicine technique and data security, although male patients were more skeptical with regard to data security (confidence scale 1-4: 1.67 vs 2.09; p> 0.05). Conclusion: Our patients desire telemedicine as an improved support for their outpatient care, expecting higher quality of life and increased therapy safety. Although, our data show that many patients are not aware about this new therapy service. We suggest extensive information and elucidation as well as further surveys to investigate the detailed needs of LVAD patients regarding telemonitoring. This will prepare for implementation of telemonitoring as a successful method in outpatient care of LVAD patients.
6( 87) Prolonged Circulatory Support (Five Years or Longer) with Left Ventricular Assist Devices for Patients with Advanced Heart Failure A. Segura ,1 A. Nair,2 C. Kurihara,2 S. Carranza,1 A. Civitello,2 J. Morgan,2 O. Frazier.1 1Texas Heart Institute, Houston, TX; 2Baylor College of Medicine, Houston, TX. Purpose: For patients in advanced heart failure, left ventricular assist devices (LVADs) may provide long-term circulatory support and clinical improvement when implanted as a bridge to transplant or destination therapy. We examined the characteristics and outcomes of patients at our institution who received LVAD support for 5 years or longer. Methods: We reviewed pre-implantation clinical and hemodynamic data from patients who received an LVAD between July 2001 and September 2011, and we followed their outcomes and complications up to September 2016. Results: Thirty-nine patients (33 men, 6 women; age 48.9±15 years [range, 17-78 years]) received LVAD support for a mean of 6.5 ± 1.8 years (range 5-9.5 years). Initially, patients received a HeartMate XVE (n= 10), HeartMate II (HMII; n= 2 5), HeartWare (HW; n= 3 ), or DuraHeart (D; n= 1) LVAD. All XVEs were exchanged for the HMII. At the end of the study period, 21 patients remained on support, 15 had died, 2 had received heart transplants, and 1 patient’s LVAD had been explanted (Table 1). Conclusion: LVADs can provide prolonged circulatory support for over 5 years. This technology has demonstrated effective long-term support and survival for end-stage heart failure patients without necessitating heart transplant. Further research is required to determine predictors of major complications in patients undergoing long-term support.
Table 1 Characteristics and complications of patients on prolonged (≥ 5 years) LVAD support.
Device Support time, years Age, years Gender Cardiomyopathy LVEF, % Cardiac Index, L/ min/m2 LVEDD,cm PAP,mmHg PCWP, mmHg Complications Stroke, number of events GI Bleeding, number of events
Remain on support N= 21
Heart Transplant N= 2
Explant Death N= 15 N= 1
17HMII,3HW, 1D 6.5 ± 1.5
2 HMII
15HMII
HMII
6.4
6.6 ± 1.3
5.5
49.2± 15.5 18M, 3F I= 7, NI= 14 21± 3 1.6± 0.4
43.5 2M 2 NI 20 2.4
50.9± 14.4 12M,3F I= 7, NI= 8 21.5± 4.5 1.7± 0.5
25 M NI 20 1.5
7.2± 1.2 42.2± 5.3 33.9± 5.3
8.7 48 25
7.1± 1.2 43.7± 12.6 28.3± 11.1
5.5 45 45
9
1
15
0
4
2
18
0
6( 88) Self-Reported and Directly Measured Physical Activity in Children and Youth with Cardiomyopathies J. Conway ,1 L. Glass,1 C. Cunningham,1 J. Stearns,2 V. Carson,2 P.F. Kantor,1 S. Urschel,1 J.C. Spence.2 1Stollery Children's Hospital, Edmonton, AB, Canada; 2University of Alberta, Edmonton, AB, Canada. Purpose: Exercise intolerance is a hallmark of heart failure in children and adults. Because of size limitations, objective measures of exercise or physical activity (PA) are infrequently obtained in pediatric patients. Accordingly, practitioners often rely on subjective reporting from families. Previous studies in other patient populations suggest that biases may be present in this form of reporting; therefore we aimed to determine the PA level in pediatric cardiomyopathy patients by parental report and accelerometry. Methods: Pediatric patients with cardiomyopathy were recruited from heart function clinic from April 2015 to October 2016 to wear the Actigraph GT3X+ accelerometer over a 7-day period to objectively assess PA levels. In addition, the families were asked to complete the Habitual Activity Estimation Scale (HAES) to capture subjective reported levels of PA we aimed to determine the PA level in pediatric cardiomyopathy patients by parental report and accelerometry. Results: Twelve patients, 75% male with a mean age of 10.3 years (SD ±3.8) were recruited. The most common diagnosis was HCM (n= 7), followed by LVNC (n= 3), and DCM (n= 2). All patients fell into either ROSS or NYHA class 1 or 2. Two-thirds of patients participated in gym class and half in extracurricular sports with a third being exercise restricted. The HAES scores indicated that 66.7% of participants were either very active or active, with only 1 patient being categorized as somewhat inactive. Accelerometer data revealed that the average time spent in moderate-vigorous physical activity (MVPA) was 50.6 mins/d (SD ± 32.1) and sedentary time was 474 mins/day (SD ±121.4). The average number of steps was 8216 per day (SD ± 3783). In comparison to Canadian norms, these children engaged in less MVPA and took far fewer steps per day than their peers. This was especially the case among girls and adolescents. Conclusion: Although the majority of families reported the participants as being active to very active, accelerometer data reveals that PA levels were less than that expected for Canadian children. This preliminary data suggests that families may overestimate the degree of PA in pediatric cardiomyopathy patients and that more direct or objective measures may be useful to help determine true levels of PA when assessing for clinical deterioration.
6( 89) WITHDRAWN
6( 87) Prolonged Circulatory Support (Five Years or Longer) with Left Ventricular Assist Devices for Patients with Advanced Heart Failure A. Segura ,1 A. Nair,2 C. Kurihara,2 S. Carranza,1 A. Civitello,2 J. Morgan,2 O. Frazier.1 1Texas Heart Institute, Houston, TX; 2Baylor College of Medicine, Houston, TX. Purpose: For patients in advanced heart failure, left ventricular assist devices (LVADs) may provide long-term circulatory support and clinical improvement when implanted as a bridge to transplant or destination therapy. We examined the characteristics and outcomes of patients at our institution who received LVAD support for 5 years or longer. Methods: We reviewed pre-implantation clinical and hemodynamic data from patients who received an LVAD between July 2001 and September 2011, and we followed their outcomes and complications up to September 2016. Results: Thirty-nine patients (33 men, 6 women; age 48.9±15 years [range, 17-78 years]) received LVAD support for a mean of 6.5 ± 1.8 years (range 5-9.5 years). Initially, patients received a HeartMate XVE (n= 10), HeartMate II (HMII; n= 2 5), HeartWare (HW; n= 3 ), or DuraHeart (D; n= 1) LVAD. All XVEs were exchanged for the HMII. At the end of the study period, 21 patients remained on support, 15 had died, 2 had received heart transplants, and 1 patient’s LVAD had been explanted (Table 1). Conclusion: LVADs can provide prolonged circulatory support for over 5 years. This technology has demonstrated effective long-term support and survival for end-stage heart failure patients without necessitating heart transplant. Further research is required to determine predictors of major complications in patients undergoing long-term support.
Table 1 Characteristics and complications of patients on prolonged (≥ 5 years) LVAD support.
Device Support time, years Age, years Gender Cardiomyopathy LVEF, % Cardiac Index, L/ min/m2 LVEDD,cm PAP,mmHg PCWP, mmHg Complications Stroke, number of events GI Bleeding, number of events
Remain on support N= 21
Heart Transplant N= 2
Explant Death N= 15 N= 1
17HMII,3HW, 1D 6.5 ± 1.5
2 HMII
15HMII
HMII
6.4
6.6 ± 1.3
5.5
49.2± 15.5 18M, 3F I= 7, NI= 14 21± 3 1.6± 0.4
43.5 2M 2 NI 20 2.4
50.9± 14.4 12M,3F I= 7, NI= 8 21.5± 4.5 1.7± 0.5
25 M NI 20 1.5
7.2± 1.2 42.2± 5.3 33.9± 5.3
8.7 48 25
7.1± 1.2 43.7± 12.6 28.3± 11.1
5.5 45 45
9
1
15
0
4
2
18
0
6( 88) Self-Reported and Directly Measured Physical Activity in Children and Youth with Cardiomyopathies J. Conway ,1 L. Glass,1 C. Cunningham,1 J. Stearns,2 V. Carson,2 P.F. Kantor,1 S. Urschel,1 J.C. Spence.2 1Stollery Children's Hospital, Edmonton, AB, Canada; 2University of Alberta, Edmonton, AB, Canada. Purpose: Exercise intolerance is a hallmark of heart failure in children and adults. Because of size limitations, objective measures of exercise or physical activity (PA) are infrequently obtained in pediatric patients. Accordingly, practitioners often rely on subjective reporting from families. Previous studies in other patient populations suggest that biases may be present in this form of reporting; therefore we aimed to determine the PA level in pediatric cardiomyopathy patients by parental report and accelerometry. Methods: Pediatric patients with cardiomyopathy were recruited from heart function clinic from April 2015 to October 2016 to wear the Actigraph GT3X+ accelerometer over a 7-day period to objectively assess PA levels. In addition, the families were asked to complete the Habitual Activity Estimation Scale (HAES) to capture subjective reported levels of PA we aimed to determine the PA level in pediatric cardiomyopathy patients by parental report and accelerometry. Results: Twelve patients, 75% male with a mean age of 10.3 years (SD ±3.8) were recruited. The most common diagnosis was HCM (n= 7), followed by LVNC (n= 3), and DCM (n= 2). All patients fell into either ROSS or NYHA class 1 or 2. Two-thirds of patients participated in gym class and half in extracurricular sports with a third being exercise restricted. The HAES scores indicated that 66.7% of participants were either very active or active, with only 1 patient being categorized as somewhat inactive. Accelerometer data revealed that the average time spent in moderate-vigorous physical activity (MVPA) was 50.6 mins/d (SD ± 32.1) and sedentary time was 474 mins/day (SD ±121.4). The average number of steps was 8216 per day (SD ± 3783). In comparison to Canadian norms, these children engaged in less MVPA and took far fewer steps per day than their peers. This was especially the case among girls and adolescents. Conclusion: Although the majority of families reported the participants as being active to very active, accelerometer data reveals that PA levels were less than that expected for Canadian children. This preliminary data suggests that families may overestimate the degree of PA in pediatric cardiomyopathy patients and that more direct or objective measures may be useful to help determine true levels of PA when assessing for clinical deterioration.
6( 89) WITHDRAWN