Destination LVAD Therapy in African American (AA) Recipients: A Single Center Experience

Purpose Despite the approval of LVADs as destination therapy (DT) nearly 2 decades ago, significant knowledge gaps remain regarding the characteristics and outcomes of AA patients (pts) who receive LVAD therapy as DT. The present analysis sought to assess the characteristics and outcomes of DT LVAD AA pts. Methods Single center retrospective review of DT LVAD pts from 1/1/2009 to 12/31/2019 was performed. We compared clinical characteristics of AAs to non-AAs. Survival and hemocompatibility-related adverse event (HRAE) rates for AA pts were determined. Uni- and multivariate predictors of mortality were identified. Results 256 pts underwent DT LVAD implantation, of which 180 (70%) were AA. 63 pts received a HMII, 54 HVAD, and 63 HM3. Compared to non-AAs, AA pts were younger (AA: 57 ± 12 vs non-AA: 67 ± 9), more likely to be female (33% vs 16%) have HTN (71% vs 57%), had a higher BMI (mean BMI 30 ± 8 vs 26 ± 5), a non-ischemic cardiomyopathy (76% vs 33%), and a history of stroke/TIA (19% vs 8%). There were no significant differences between the 2 groups in terms of INTERMACS profile. Post-operatively, the AA cohort required more days of vasopressor support (9.5 ± 14 vs. 6.0 ± 6) and had a higher postoperative length of stay (32.9 ± 21.0 vs. 26.2 ± 21.9 days). Among AAs, GI bleeding was the most common HRAE (44% of patients with events per patient year, EPPY 0.55) followed by stroke (22%, EPPY 0.13) and pump thrombosis (16%, EPPY 0.13). The HM3 was associated with lowest HRAE rates (EPPY) amongst the 3 devices (GIB 0.40, stroke 0.07, and no pump thrombosis events). Overall survival among AA DT pts was 81% and 69% at 1-year and 2-years. 5-year survival was 41%. On univariate analysis, history of prior sternotomy (HR 1.93, 95% CI 1.03-3.59, p=0.04) and total bilirubin (HR 1.21, 95% CI 1.04-1.40, p=0.01) were predictors of AA mortality while INTERMACS profile ≥3 (HR 0.67, 95% CI 0.49-0.93, p=0.02) was associated with improved survival. Total bilirubin was the only independent predictor of mortality in multivariate analysis (HR 1.18, 95% CI 1.0-1.4, p=0.05). Conclusion AA DT LVAD pts experienced excellent 1- and 2-year survival comparable to those demonstrated in large clinical studies. HM3 implantation was associated with lower rates of GIB, pump thrombosis, and stroke. Future research focused on barriers to LVAD therapy and the quality of life of AA LVAD pts is warranted.