Dear Editor,

We have currently reviewed the article entitled “ Long-term outcomes of elderly patients receiving continuous flow left ventricular support “ by Nicolas A. Brozzi with deep interest.¹ Objectives of the study are well portrayed and author’s work is highly appreciated and need to be endorsed by the readers. We agree with the prime conclusion of the study that continuous left ventricular support tend to produce less complications for first few years and is highly recommended for those who are having minimal chances of receiving heart transplantation. However few concerns arises regarding validity of the study.

Firstly, considering incomplete patient characteristics and elements can amend the legitimacy of the study. Therefore while including the patients in the study, the author’s should have assessed the patient variables and expanded their selection criteria. For illustration 2009 study included additional risk factor such as reduced renal function and found strong association with the patients undergoing ventricular support.² Additonally nosocomial infections plays important role in prognosis and mortality of the patient. This is why the author’s should have included history of prophylactic and postoperative antibiotics administered. For example a 2010 study added that patient after being infected by atleast one type of infection tends to have longer hospital stays and thus increased in hospital mortality.³

Thirdly, as established pump thrombosis as one of the long term postoperative complication of ventricular support and to reduce the risk some studies for example a 2015 study have shown to include Asprin 81 mg and Warfarin with an INR target of 2.0-2.5 as postoperative therapy. Therefore author’s should have asked for postoperative history of drug administration.⁴ Moreover this study emerges with various concerns due to its single centered origin. To overcome this issue, the author’s should have include participants from different hospital setting due to effect of different cultural and socioeconomic status of an individual. For illustration a 2013 study opted to include participants from multicentered setting.⁵

1- Brozzi NA, Cifuentes RO, Saba IC, Macon C, Ghodsizad A, Andreopoulos F, Loebe M. Long-term outcomes of elderly patients receiving continuous flow left ventricular support. J Card Surg. 2020 Dec;35(12):3405-3408. doi: 10.1111/jocs.15074. Epub 2020 Oct 1. PMID: 33001467.

2- Sandner SE, Zimpfer D, Zrunek P, Rajek A, Schima H, Dunkler D, Grimm M, Wolner E, Wieselthaler GM. Renal function and outcome after continuous flow left ventricular assist device implantation. Ann Thorac Surg. 2009 Apr;87(4):1072-8. doi: 10.1016/j.athoracsur.2009.01.022. PMID: 19324130.

3- Topkara VK, Kondareddy S, Malik F, Wang IW, Mann DL, Ewald GA, Moazami N. Infectious complications in patients with left ventricular assist device: etiology and outcomes in the continuous-flow era. Ann Thorac Surg. 2010 Oct;90(4):1270-7. doi: 10.1016/j.athoracsur.2010.04.093. PMID: 20868826.

4- Tsiouris A, Paone G, Nemeh HW, Borgi J, Williams CT, Lanfear DE, Morgan JA. Short and long term outcomes of 200 patients supported by continuous-flow left ventricular assist devices. World J Cardiol. 2015 Nov 26;7(11):792-800. doi: 10.4330/wjc.v7.i11.792. PMID: 26635927; PMCID: PMC4660474.

5- Cowger J, Sundareswaran K, Rogers JG, Park SJ, Pagani FD, Bhat G, Jaski B, Farrar DJ, Slaughter MS. Predicting survival in patients receiving continuous flow left ventricular assist devices: the HeartMate II risk score. J Am Coll Cardiol. 2013 Jan 22;61(3):313-21. doi: 10.1016/j.jacc.2012.09.055. Epub 2012 Dec 19. PMID: 23265328.