We read with great interest the article by Zhang et al, “Application of Left Ventricular Assist Device in Heart Failure Management: A Single-Center Experience” (2025).[1] The study provides important lessons for optimizing left ventricular assist device (LVAD) outcomes in real-world practice. Reporting on 127 LVAD implants performed between 2017 and 2021, the authors highlight substantial NYHA class improvement, with a 2-year survival of 61.9% for 2017 to 2020 implants compared with a 78% early survival among post-2021 recipients.

An important consideration is the comparability of these survival figures. Different follow-up durations limit direct interpretation. Presenting Kaplan–Meier survival curves and standardized event rates per 100 patient-years would align with best practices in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) and European Registry for Patients with Mechanical Circulatory Support (EUROMACS).[2] [3] For context, recent International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support Registry (IMACS) data show 2-year survival above 70% in most regions,[2] and EUROMACS reports a median of 72.5%.[3] Benchmarking against these registries could help identify both institutional strengths and opportunities for improvement.

Another point worth noting is the high incidence of postoperative respiratory failure (44.8%), nearly twice that reported in large registries.[2] [3] Contributing factors may include high preoperative ventilator dependence, unassessed diaphragmatic dysfunction, and liberal perioperative fluid strategies. A 2024 multicenter study demonstrated that preoperative diaphragm ultrasound screening combined with goal-directed fluid therapy reduced respiratory failure risk by 27%.[4] Integrating such a standardized extubation pathway may offer considerable benefit.

Equally important is the reported 37% incidence of driveline infection. Beyond surgical tunneling, a 2023 multi-institutional protocol incorporating structured exit-site care, patient self-inspection training, and photographic monitoring lowered infection rates by more than 30%.[5] We believe adopting and prospectively evaluating such a bundle could yield immediate clinical gains.

We also note the absence of device- and surgical approach-specific stratification, which limits interpretation. While the transition from pulsatile to continuous-flow devices and the potential advantages of the HeartMate 3 are mentioned, the Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 (MOMENTUM3) trial demonstrated HeartMate 3 left ventricular assist device's (HM3) superiority in freedom from stroke and pump thrombosis.[6] More recently, a 2024 multicenter analysis found that HM3 speed modulation may further reduce gastrointestinal bleeding.[7] Stratifying complications such as stroke (26%) and gastrointestinal bleeding (24.4%) by device type and surgical access could help identify modifiable risk factors.

This leads us to several clinically relevant questions: Which patient-level variables predict early respiratory failure, and can they be addressed preoperatively? How do bridge-to-transplant and destination therapy recipients differ in outcomes? Could preimplant right ventricular optimization, including pulmonary vasodilators or temporary right ventricle support, reduce the observed 14.2% incidence of postoperative right heart failure?

In conclusion, these lessons from a single-center experience, when integrated with standardized reporting and prevention-focused strategies, have the potential to enhance LVAD care. We hope these observations will stimulate further research and dialogue aimed at advancing mechanical circulatory support outcomes worldwide.

Received: 09 August 2025

Accepted: 19 September 2025

Article published online:
15 October 2025

© 2025. International College of Angiology. This article is published by Thieme.

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