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Peer-reviewedCC BY-NCESC heart failure

Predicting survival beyond 5 years on continuous-flow left ventricular assist device: a landmark analysis from the STELLAR registry.

  • Claudio Velásquez-Silva1
  • William H Nielsen2
  • Christian H Møller3
  • Kasper Rossing2
  • Angelika Costard-Jäckle1
  • René Schramm1
  • Michiel Morshuis1
  • Jan F Gummert1
  • Finn Gustafsson4,5
  • Sebastian V Rojas1
  • Henrik Fox1
5 affiliations
  1. 1Heart Failure Center, Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen (HDZ NRW), University Hospital of the Ruhr-University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany.
  2. 2Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
  3. 3Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark.
  4. 4Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
  5. 5Abbott, Chicago, IL, USA.
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Abstract

Introduction

Five-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.Methods

We 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.Results

Among 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).Conclusion

Among 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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Cite

BibTeXRIS
BibTeX
@article{velasquezsilva2026predicting,
  title = {{Predicting survival beyond 5 years on continuous-flow left ventricular assist device: a landmark analysis from the STELLAR registry.}},
  author = {Claudio Velásquez-Silva and William H Nielsen and Christian H Møller and Kasper Rossing and Angelika Costard-Jäckle and René Schramm and Michiel Morshuis and Jan F Gummert and Finn Gustafsson and Sebastian V Rojas and Henrik Fox},
  journal = {ESC heart failure},
  year = {2026},
  month = aug,
  doi = {10.1093/eschf/xvag257},
  url = {https://europepmc.org/article/MED/42841476},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Predicting survival beyond 5 years on continuous-flow left ventricular assist device: a landmark analysis from the STELLAR registry.
AU  - Claudio Velásquez-Silva
AU  - William H Nielsen
AU  - Christian H Møller
AU  - Kasper Rossing
AU  - Angelika Costard-Jäckle
AU  - René Schramm
AU  - Michiel Morshuis
AU  - Jan F Gummert
AU  - Finn Gustafsson
AU  - Sebastian V Rojas
AU  - Henrik Fox
PY  - 2026
DA  - 2026/08/01
JO  - ESC heart failure
DO  - 10.1093/eschf/xvag257
UR  - https://europepmc.org/article/MED/42841476
AB  - Introduction  Five-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.Methods  We 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.Results  Among 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).Conclusion  Among 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.
SN  - 2055-5822
ER  -