Résumé
Background: While heart failure (HF) duration before left ventricular assist device (LVAD) implantation may influence postoperative outcomes, data evaluating this relationship remains limited. This study investigated the association between HF duration and outcomes following LVAD implantation.Methods: This international retrospective multicenter study included 1,071 patients who underwent LVAD implantation between 2006-2019. Patients were stratified into quartiles by HF duration before implantation: Q1 ≤ 3.9 months, Q2 > 3.9 months-4 years, Q3 > 4-10.7 years, and Q4 ≥ 10.7 years. Primary outcome was 3-year all-cause mortality. Secondary outcomes included cardiac death, early (≤ 30 days) and late ventricular arrhythmias (VAs), and left ventricular ejection fraction (LVEF) recovery. Multivariable Cox regression and restricted cubic spline analyses were performed.Results: After 3-year follow-up, 426 patients died (31.1% in Q1 vs 48.5% in Q4). Patients with longest HF duration (Q4) had higher mortality risk compared to Q1 (aHR 1.57 [1.18-2.09]) and cardiac death risk (aHR 1.69 [1.13-2.55]). Early VAs increased progressively with HF duration, with Q3 (aHR 1.74 [1.19-2.53]) and Q4 (aHR 1.79 [1.23-2.60]) showing significantly elevated risks. Late VAs demonstrated the most pronounced association (Q4 vs Q1: aHR 5.75 [3.46-9.26]). LVEF recovery decreased progressively, with major LVEF improvement (≥ 10%) occurring in 37% of Q1 versus 19.4% of Q4 patients.Conclusion: Prolonged HF duration before LVAD implantation was associated with worse outcomes, emphasizing the importance of timely referral to specialized centers and optimized care pathways for advanced HF management.