Learning Curve in Left Ventricular Assist Device Implantation: Low Volumes Do Not Equate Bad Outcomes

Learning Curve in Left Ventricular Assist Device Implantation: Low Volumes Do Not Equate Bad Outcomes

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ABSTRACT Introduction: Most implantations of left ventricular assist devices (LVAD) are performed in low-volume centers.This study aimed to evaluate the procedural learning curve of HeartMate II (HM2) implantations by comparing outcomes between two time periods in a low-volume center.Methods: All 51 consecutive patients undergoing HM2 implantation between January 2009 and December 2017 were reviewed and allocated into 2 groups: early-era group (from 2009 verona wig to 2014; n=25) and late-era group (from 2015 to 2017; n=26).The primary outcome was the 90-day mortality rate, and the secondary outcome was a composite of mortality, neurological event, reoperation for bleeding, need for temporary right ventricular assist device, and pump thrombosis at 90 days.

Median follow-up time was 51 months (0-136).A cumulative sum (CUSUM) control analysis was used to establish a threshold of implantations that optimizes outcomes.Results: Patients in the early era had a higher rate of diabetes, previous stroke, and inotrope support before HM2 implantation.The 90-day mortality rate was not significantly higher in the early era (24% vs.

15%, P=0.43), but the composite endpoint was significantly higher (76% vs.42%, P=0.01).

The CUSUM analysis found a threshold of 23 operations after which the composite endpoint was optimized.Conclusion: Patients undergoing HM2 implantation in a low-volume center have improving outcomes with number of cases and optimized results after a threshold of 23 cases.Significant changes in patient selection, surgical techniques, and patient management might lead rubbermaid 8 gallon trash can to improved outcomes after LVAD implantation.