Author + information
- Received December 4, 2018
- Revision received January 16, 2019
- Accepted January 16, 2019
- Published online February 25, 2019.
- Ersilia M. DeFilippis, MDa,
- Lauren K. Truby, MDb,
- A. Reshad Garan, MDa,
- Raymond C. Givens, MDa,
- Koji Takeda, MD, PhDc,
- Hiroo Takayama, MD, PhDc,
- Yoshifumi Naka, MD, PhDc,
- Jennifer H. Haythe, MDa,
- Maryjane A. Farr, MDa and
- Veli K. Topkara, MD, MSa,∗ ()
- aDivision of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- bDivision of Cardiology, Duke University Medical Center, Durham, North Carolina
- cDivision of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
- ↵∗Address for correspondence:
Dr. Veli K. Topkara, Center for Advanced Cardiac Care, Columbia University Medical Center – New York Presbyterian, 622 West 168th Street, PH10-203A, New York, New York 10032.
Objectives This study examined sex-related differences in use and outcomes of continuous-flow left ventricular assist devices (CF-LVADs) among individuals awaiting heart transplantation using the United Network for Organ Sharing registry.
Background Advanced therapies for heart failure including CF-LVADs remain underused in women. There have been contradictory results regarding sex-specific outcomes. Many studies have been limited by small sample sizes or included pulsatile-flow devices.
Methods De-identified patient-level data were obtained from the United Network for Organ Sharing database. The database was queried to identify adult patients (≥18 years of age) who required mechanical circulatory support with HeartWare HVAD (Medtronic, Minneapolis, Minnesota), HeartMate II (Abbott, Lake Bluff, Illinois), or HeartMate 3 (Abbott) as bridge to heart transplantation between 2008 and 2018. Each patient was assigned a propensity score. The primary outcomes of interest were rates of transplantation and death.
Results A total of 13,305 patients (2,771 women, 20.8%) received support with CF-LVAD in the study period. There were significant sex disparities in CF-LVAD use in listed patients (29.9% men vs. 18.9% women in 2017). Female patients receiving CF-LVAD support had lower chances of heart transplantation (55.1% vs. 67.5%), increased risk of waitlist mortality (7.0% vs. 4.2%), and delisting for worsening clinical status (8.5% vs. 4.7%) at 2 years post-implantation (all p < 0.001). After adjusting for device type, sex was still a significant predictor of waitlist mortality (hazard ratio: 1.51; p < 0.001).
Conclusions Durable mechanical circulatory support with CF-LVADs remains underused in women. When matched with similar male control subjects, women experienced higher mortality and lower rates of heart transplantation.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 4, 2018.
- Revision received January 16, 2019.
- Accepted January 16, 2019.
- 2019 American College of Cardiology Foundation
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