Magnus Ari Brynleifsson1

Aevar Orn Ulfarsson2

Martin Ingi Sigurdsson3,4

 

1Department of Internal Medicine, Landspítali University Hospital, 2Department of Cardiology, Landspítali University Hospital, 3Faculty of Medicine, University of Iceland, 4Department of Anesthesiology and Intensive Care, Landspítali University Hospital.

 

Correspondence: Martin Ingi Sigurdsson 

 

Key words: ventricular assist device, mechanical circulatory support, advanced heart failure, Iceland

Introduction: Ventricular assist devices are increasingly used as a treatment option for patients with advanced heart failure, however, there is a lack of information about the number of patients, indications, and outcomes of this patient population in Iceland.

Methods and materials: A retrospective study covering the period 01.01.2020 - 31.12.2024. The study population consisted of individuals who had received a ventricular assist device and had received treatment or follow-up care in Iceland either before or after implantation of the ventricular assist device. Clinical data were obtained from electronic medical records, and variables were collected before and after implantation.

Results: Between 2010 and 2024, six individuals received a ventricular assist device (VAD), all of whom were male. The age at implantation ranged from 17 to 66 years. Indications for VAD implantation were equally divided between bridge to transplantation (3/6) and bridge to candidacy (3/6). The underlying causes of heart failure were dilated cardiomyopathy (5/6) and ischemic cardiomyopathy (1/6). Four patients received a left ventricular assist device, while two received a biventricular assist device. Four patients subsequently underwent heart transplantation, one died while on VAD support, and one remained on VAD therapy at the end of the study period. The mean time from VAD implantation to heart transplantation was 249 days. Throughout the study period, there were a total of 1704 days on which at least one patient with a VAD was located in Iceland, corresponding to 31% of the study period. Four complications were documented in three patients: driveline infection, ventricular tachycardia, gastrointestinal bleeding and subarachnoid hemorrhage due to syncope.

Conclusions: Patients with VADs were effectively managed in Iceland, and the results imply that the use of VADs possibly represents a currently underutilized therapeutic option for advanced heart failure in Iceland.

Table I. Criteria for advanced heart failure. Adapted from ESC guidelines on management of acute- and chronic heart failure from 2021.3 

Abbreviations: NYHA; New York Heart Association, BNP; brain natriuretic peptide, NT-proBNP; N-terminal pro b-type natriuretic peptide.

Table II. Description of the INTERMACS classification system (Interagency Registry of Mechanically Assisted Circulatory Support). Translated and adopted from Stevenson et. al., 2009.

Table III. Preclinical data before implantation; Range (range width) and n

Abbreviations: NYHA; New York Heart Association, INTERMACS, Interagency Registry for Mechanically Assisted Circulatory Support, VO2max; maximum oxygen consumption, ACEi; angiotensin-converting enzyme inhibitor, ARB; angiotensin II receptor blocker, ARNI; angiotensin receptor-neprilysin inhibitor, MRA; mineralocorticoid receptor antagonist, SGLT2i; sodium-glucose cotransporter 2 inhibitor, CRT-D; cardiac resynchronisation therapy with defibrillator, ICD; implantable cardioverter-defibrillator.

Table IV. Last blood results in Iceland before implantation of ventricular assist device.

Abbreviations: NT-pro-BNP; N-terminal pro-B-type natriuretic peptide, LD; lactate dehydrogenase, INR, international normalized ratio.