11 Success with MCS - starting from patient selection

Since the introduction of continuous flow (CF-)VADs a decade ago,1 early and mid-term survival rates have dramatically improved with 1 year survival of 85% or higher.2 3 These better survival rates should not only be attributed to improvement in technology and patient management but also to better patient selection and better timing of implantation.1From the REMATCH study (2001) with the pulsatile HeartMate 1 LVAS we learned that the high 6 month mortality of 40% was mainly a result of poor selection of patients. Since the introduction of CF-VADs in 2008, the INTERMACS registry has shown a significant reduction in INTERMACS Profile 1 (‘crashing and burning’) VAD patients at the time of implantation, resulting in 6 month survival rates of 90% or higher. Also, the HeartMate II ROADMAP Study has shown that earlier implantation in less sick non-hospitalised patients results in statistically better survival.4 During the last decade, introduction of individual patient risk profiles such as the Lietz-Miller score, Michigan Score (Matthews, 2008) and the HeartMate II risk score has attributed to improved patient selection.2 In this regard in many publications the importance of pre-implant assessment by ultrasound or haemodynamic metrics of the right ventricular function and its pre- and afterload (i.e. pulmonary vascular resistance or PVR) has been stressed to optimise the patient obtaining a better result of VAD implantation.5 This has resulted in many other risk stratif...
Source: Heart Asia - Category: Cardiology Authors: Tags: APAHFF Abstracts 2017 Source Type: research