Impact of centrifugal-flow left ventricular assist device implantation on the disease course, functional class, and quality of life in patients with end-stage heart failure with reduced ejection fraction. A 6-month follow-up experience

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Aim. To study mortality, postoperative complications, clinical course, and quality of life of patients with heart failure (HF) within 6 months after left ventricular assist device (LVAD) implantation. Material and methods. The study included 53 patients who met the criteria for LVAD implantation. Twenty three patients underwent surgery (group 1), while 30 patients refused implantation (group 2). The follow-up period was 6 months. The death number and causes, hospitalization and HF decompensation rates, the changes of N-terminal pro-brain natriuretic peptide levels, the functional class of HF, the incidence of postoperative complications were assessed. Exercise tolerance (ET) was determined using a 6-minute walk test, while quality of life — using the EQ-5D questionnaire. Results. Patient mortality in the LVAD group was 26%, while in group 2 — 23,3%. In the main group, 1 patient died due to cardiovascular cause; 2 — gastrointestinal bleeding; 1 — infectious complications (sepsis); 1 — cerebrovascular accident; 1 — acute non-occlusive mesenteric ischemia. In the control group, all death cases were due to cardiovascular pathology. Among the complications after implantation, the most common were pleurisy, delirium, ventricular tachycardia, right ventricular failure, gastrointestinal bleeding, LVAD-associated infection. In group 1, there was a significantly lower number of rehospitalizations compared to group 2, including those due to HF decompensation (p=0,034, p<0,001, respectively). In the main group, there was an improvement in the quality of life (p<0,001), HF class (p<0,001), and ET (p=0,006), which led to a reliable difference between the groups after 6 months. Conclusion. LVAD implantation is accompanied by a decrease in the number of rehospitalizations and HF decompensation, as well as improvement of ET, HF class and quality of life of patients, but not a decrease in mortality. To reduce the incidence of postoperative complications and improve the prognosis, a more careful selection of patients for intervention, assessment of their cognitive status and compliance is necessary.

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