5 mechanical circulatory support programme: experience in hong kong

Background Left ventricular assist device (LVAD) has been used for end-stage heart failure both as bridge to transplantation (BTT) and destination therapy (DT) for patients not suitable for heart transplantation. We aimed to review the experience of LVAD therapy in Hong Kong. Method Patients who had LVAD implantation from August 2010 to October 2017 for end-stage heart failure were reviewed. Results A total of 55 patients had LVAD implanted for end-stage heart failure (48 as BTT, 87.3%). Majority are male (n=45, 81.8%) with mean age 49 years, and mean left ventricular ejection fraction 17%. Most patients were INTERMACS 2 to 3 (n=43, 78.2%) while nine patients (16.4%) were INTERMACS 1. Overall survival rates were 84.7% at 6 months, 80.8% at 12 months, 78.3% at 2 year and 68% at 4 year. Long-term survival was not significantly different between BTT and DT groups (70.1% vs 51.4% at 4 year, p=0.099 by log-rank) while survival was significantly inferior for INTERMACS 1 patients (26.7% vs 76.2% at 4 year, p=0.016 ). Most common complication was driveline infection (29.1%) followed by cerebrovascular accident (23.6%), gastrointestinal bleeding (20%), ventricular arrhythmia (14.5%), right heart failure (10.9%), sepsis (9.1%) and driveline malfunction (7.3%). Pump thrombosis occurred in only 1 case (1.8%). Conclusion LVAD therapy as BTT has become the standard therapy for potential heart transplant candidates in Hong Kong and its role as DT is also emerging. Timely recognition and referral is the key to achieve the best outcome in this sick patient population.