Observational studyESC heart failure2026
Predicting survival beyond 5 years on continuous-flow left ventricular assist device: a landmark analysis from the STELLAR registry.
Observational study in ESC heart failure, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
11 authors.
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Abstract
introductionFive-year survival after continuous-flow left ventricular assist device (LVAD) implantation has improved substantially, resulting in a growing population of ultra-long-term LVAD patients, defined as 5 years and longer survival on LVAD. Remarkably, determinants of mortality beyond the 5-year landmark remain poorly characterized, and ultra-long-term outcomes are rarely investigated.
methodsWe performed a large bicentre observational landmark analysis including patients who survived at least 5 years on LVAD support. Implanted devices included HeartMate II, HeartWare (HVAD), and HeartMate 3. Clinical, laboratory, echocardiographic, and haemodynamic parameters at the 5-year time point were evaluated to represent predictors of mortality. Cox proportional hazards regression was used to identify independent predictors of mortality from the 5-year landmark. Model discrimination was assessed using Harrell's C-index and time-dependent area under the curve.
resultsAmong 201 patients surviving ≥5 years on LVAD support, 189 had complete data for multivariable analysis. Median age at implantation was 59.9 years (IQR 52.6-65.8), and 86% were male. During post-landmark follow-up, 77 deaths occurred. Age (HR 1.04 per year, 95% CI 1.02-1.07; P = .002), haemoglobin (HR 0.84 per mmol/l, 95% CI 0.73-0.97; P = .016), MELD-XI score (HR 1.10 per unit, 95% CI 1.06-1.14; P < .001), and implantable cardioverter-defibrillator presence (HR 1.60, 95% CI 1.00-2.54; P = .049) were independently associated with mortality beyond the 5-year landmark. The model showed acceptable discrimination (Harrell's C-index ∼0.74). LVAD model was not independently associated with post-landmark mortality (likelihood-ratio P = .63).
conclusionAmong patients who have already survived 5 years on continuous-flow LVAD support, subsequent mortality was associated with routinely available markers of physiological and end-organ reserve. These findings characterize risk specifically in prevalent long-term LVAD recipients and warrant external validation.
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