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Left ventricular assist devices (LVADs) have emerged as an important treatment option for bridging patients with heart failure to transplant. LVADs have shown improved survival; however, the impact of LVAD type on the quality of life (QoL) while on long-term LVAD support is unknown. We aimed to evaluate the QoL of patients while supported with a LVAD in Japan. 299 patients enrolled in the Japanese Registry for Mechanically Assisted Circulatory Support (J-MACS), who were listed for transplant or likely to be listed, received a LVAD from 2010 to 2018 and had full QoL data, were enrolled. QoL data, such as visual analogue scale (VAS) and EQ-5D-3L by 5 dimensions (5D: mobility, self-care, usual activities, pain/discomfort and anxiety/depression) before and at 3- and 12-months after implantation of a LVAD were obtained from the J-MACS Registry. These patients were divided into 3 groups; primary implantable LVAD (iLVAD) (N=263), primary paracorporeal LVAD (pLVAD) (N=9) and bridge from paracorporeal to implantable LVAD (BTB) (N=27). VAS in all groups significantly increased from before to 3- and 12-months after LVAD implantation(p<0.001). VAS in pLVAD group before and 3- and 12-months after LVAD implantation were significantly lower than those in BTB and iLVAD groups (32.2±28.5, 61.4±23.2 and 62.3±23.1 in pLVAD, 42.7±19.2, 74.0±14.6 and 74.3±19.3 in BTB and 47.4±24.9, 71.1±18.2 and 72.9±18.2 in iLVAD, respectively). The proportions of some and/or extreme problems in mobility, self-care and usual activities before LVAD implantation in pLVAD group were 100%, while those in BTB and iLVAD group were lower than 87.6%. Although the proportions of some and/or extreme problems in all dimensions in pLVAD group significantly decreased from before to 3- and 12-months after LVAD implantation, the proportions of some and/or extreme problems in all dimensions except anxiety/depression in pLVAD group were still significantly higher than those in BTB and iLVAD. QoL as VAS and 5D were significantly improved after implantation of any LVAD type. However, VAS and 5D except anxiety/depression in patients with pLVAD were significantly lower and more problems than those in patients with iLVAD. These differences were eliminated by converting from pLVAD to iLVAD. BTB might be a beneficial treatment option to improve QoL as well as patient's survival. [ABSTRACT FROM AUTHOR]

The use of a left ventricular assist device (LVAD) is an effective therapeutic option for advanced heart failure. Patients with heart failure have impaired carbon monoxide diffusing capacity (DLco), which has not been well investigated in the LVAD population. Thus, we explored the predictive value of preoperative DLco in the survival and cardiac readmission rates in patients undergoing LVAD implantations in Japan. Patients who (i) received continuous-flow LVAD as bridge-to-transplant therapy from November 2007 to September 2018 at our institution, (ii) were more than 16 years old, (iii) were not converted from extracorporeal LVAD (iv) survived until discharge, and (v) underwent pulmonary function tests before LVAD implantation were included. The eligible patients were divided into 2 groups according to preoperative percent of predicted DLco (%DLco).The primary endpoints were all-cause death and hospital readmission for heart failure or arrhythmia (cardiac readmission). We retrospectively examined the records of 76 patients, resulting in 45 patients in the low DLco group (%DLco <80%) and 31 patients in the high DLco group (%DLco ≥80%). The 2-year cardiac readmission rate was 33.5% of the patients in the low DLco group and 8.7% in the high DLco group (p = 0.028). However, the mortality rate was not different between the two groups. %DLco was found to be associated with cardiac readmission in the univariate and multivariate analyses (hazard ratio 4.32, 95% confidence interval 1.50-15.9, p = 0.005). Low %DLco is a risk factor of cardiac readmission in patients undergoing LVAD implantation. [ABSTRACT FROM AUTHOR]