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Background <p>While heart failure (HF) duration before left ventricular assist device (LVAD) implantation may influence postoperative outcomes, data evaluating this relationship remains limited. This study investigated the association between HF duration and outcomes following LVAD implantation.</p> Methods <p>This international retrospective multicenter study included 1,071 patients who underwent LVAD implantation between 2006—2019. Patients were stratified into quartiles by HF duration before implantation: Q1 ≤ 3.9&#xa0;months, Q2 &gt; 3.9&#xa0;months-4&#xa0;years, Q3 &gt; 4—10.7&#xa0;years, and Q4 ≥ 10.7&#xa0;years. Primary outcome was 3-year all-cause mortality. Secondary outcomes included cardiac death, early (≤ 30&#xa0;days) and late ventricular arrhythmias (VAs), and left ventricular ejection fraction (LVEF) recovery. Multivariable Cox regression and restricted cubic spline analyses were performed.</p> Results <p>After 3-year follow-up, 426 patients died (31.1% in Q1 vs 48.5% in Q4). Patients with longest HF duration (Q4) had higher mortality risk compared to Q1 (aHR 1.57 [1.18–2.09]) and cardiac death risk (aHR 1.69 [1.13—2.55]). Early VAs increased progressively with HF duration, with Q3 (aHR 1.74 [1.19—2.53]) and Q4 (aHR 1.79 [1.23—2.60]) showing significantly elevated risks. Late VAs demonstrated the most pronounced association (Q4 vs Q1: aHR 5.75 [3.46—9.26]). LVEF recovery decreased progressively, with major LVEF improvement (≥ 10%) occurring in 37% of Q1 versus 19.4% of Q4 patients.</p> Conclusion <p>Prolonged HF duration before LVAD implantation was associated with worse outcomes, emphasizing the importance of timely referral to specialized centers and optimized care pathways for advanced HF management.</p> Graphical abstract <p>BMI, body mass index; HF, heart failure; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction</p> <p></p>

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Duration of heart failure as a determinant of outcomes after left ventricular assist device implantation: an international multicenter study

  • 期刊论文

  • 发表日期：

    2026年5月18日

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  • Miloud Cherbi,
  • Raphael Martins,
  • Paul Gautier,
  • Karim Benali,
  • Kerstin Bode,
  • Elena Efimova,
  • Alexey Dashkevich,
  • Jackson Liang,
  • John Larson,
  • Blandine Mondesert,
  • Jacinthe Boulet,
  • Pierre-Emmanuel Noly,
  • François Picard,
  • Jean Luc Pasquié,
  • Jean-Baptiste Gourraud,
  • Sandro Ninni,
  • Laurence Jesel,
  • Alexandre Sebestyen,
  • Marylou Para,
  • Jean-Claude Deharo,
  • Frederic Anselme,
  • Laure Champ-Rigot,
  • Katrien Blanchart,
  • Soundous M’Rabet,
  • Bertrand Pierre,
  • Romain Eschalier,
  • Mathieu Echivard,
  • Anne-Céline Martin,
  • Nicolas Lellouche,
  • Matteo Pozzi,
  • Pierre Groussin,
  • Erwan Flecher,
  • Vincent Galand,
  • Clément Delmas

摘要

Background

While heart failure (HF) duration before left ventricular assist device (LVAD) implantation may influence postoperative outcomes, data evaluating this relationship remains limited. This study investigated the association between HF duration and outcomes following LVAD implantation.

Methods

This international retrospective multicenter study included 1,071 patients who underwent LVAD implantation between 2006—2019. Patients were stratified into quartiles by HF duration before implantation: Q1 ≤ 3.9 months, Q2 > 3.9 months-4 years, Q3 > 4—10.7 years, and Q4 ≥ 10.7 years. Primary outcome was 3-year all-cause mortality. Secondary outcomes included cardiac death, early (≤ 30 days) and late ventricular arrhythmias (VAs), and left ventricular ejection fraction (LVEF) recovery. Multivariable Cox regression and restricted cubic spline analyses were performed.

Results

After 3-year follow-up, 426 patients died (31.1% in Q1 vs 48.5% in Q4). Patients with longest HF duration (Q4) had higher mortality risk compared to Q1 (aHR 1.57 [1.18–2.09]) and cardiac death risk (aHR 1.69 [1.13—2.55]). Early VAs increased progressively with HF duration, with Q3 (aHR 1.74 [1.19—2.53]) and Q4 (aHR 1.79 [1.23—2.60]) showing significantly elevated risks. Late VAs demonstrated the most pronounced association (Q4 vs Q1: aHR 5.75 [3.46—9.26]). LVEF recovery decreased progressively, with major LVEF improvement (≥ 10%) occurring in 37% of Q1 versus 19.4% of Q4 patients.

Conclusion

Prolonged HF duration before LVAD implantation was associated with worse outcomes, emphasizing the importance of timely referral to specialized centers and optimized care pathways for advanced HF management.

Graphical abstract

BMI, body mass index; HF, heart failure; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction