Differences in Status 1A Heart Transplantation Survival in the Continuous Flow Left Ventricular Assist Device Era

Trivedi, Jaimin R.; Rajagopal, Keshava; Schumer, Erin M.; Birks, Emma J.; Lenneman, Andrew; Cheng, Allen; Slaughter, Mark S.

doi:10.1016/j.athoracsur.2016.04.027

Cited by 11 publications

(11 citation statements)

References 18 publications

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“…[1][2][3] Indeed, patients with CF-LVADs have historically superior waitlist survival and rates of transplantation when compared to patients supported with temporary mechanical circulatory support (TMCS). 4,5 The surmounting evidence that CF-LVAD and TMCS outcomes were discrepant was addressed during the adoption of a new multi-tiered allocation policy in October 2018. 6,7 One type of TMCS, the Impella 5.0 device (Abiomed), is a surgically implanted microaxial ventricular assist device that has the capacity to provide complete hemodynamic support with 5 L/min of flow while simultaneously unloading the left ventricle.…”

Section: Introductionmentioning

confidence: 99%

Direct bridging to cardiac transplantation with the surgically implanted Impella 5.0 device

Seese

Hickey

Keebler

et al. 2020

Clinical Transplantation

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This study evaluated outcomes of direct bridging to orthotopic heart transplantation (OHT) with the Impella 5.0 device. Adult recipients in the United Network for Organ Sharing registry bridged to OHT with the Impella 5.0 device between 2010 to 2018 were included. Outcomes included waitlist and post‐transplant survival. A total of 236 patients were wait‐listed with Impella 5.0 support, and 24% (n = 57) underwent bridge to OHT. Early and late post‐transplant survival was excellent at 96.5% at 30 day, 93.8% at 90‐day, and 90.3% at 1‐year follow‐up. Post‐transplant complications were infrequent, but the most common were renal failure requiring dialysis (8.8%, n = 5), cerebrovascular accidents (1.8%, n = 1), and pacemaker implant (1.8%, n = 1). The rate of waitlist removal for death or clinical deterioration was 20.0% (n = 47); however, the majority of patients were bridged to OHT (24%, n = 57) or durable continuous‐flow left ventricular assist device (37.0%, n = 87). The median time supported on the device, while waitlisted was 13 days (Interquartile range [IQR] 7, 20 days). The Impella 5.0 device can be used as a direct bridge to OHT with excellent survival and minimal post‐transplant morbidity. Overall, these data support the utilization of Impella 5.0 as a bridge to OHT in select patients with refractory cardiogenic shock.

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Section: Introductionmentioning

confidence: 99%

Direct bridging to cardiac transplantation with the surgically implanted Impella 5.0 device

Seese

Hickey

Keebler

et al. 2020

Clinical Transplantation

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“…Early mortality and long-term survival rates in recipients assisted by ECMO are worse than those assisted by LVAD: early mortality is 35 versus 5%, and 1-, 2-, 3-, 4-, and 5-year survival rates are 60 versus 89%, 54 versus 86%, 51.5 versus 82%, 51.5 versus 81%, and 51.5 versus 76%, respectively [88]. The one-year survival after HTx is similar in patients with LVAD (89%), but complicated postimplant recipients have worse, 3-year survival than noncomplicated postimplant recipients (78 versus 85%) [89]. Long-term survival is dependent on several factors, but the availability of the donor hearts from younger male donors with shortest ischemic times is identified as the most significant factor improving long-term survival [91].…”

Section: Cardiac Transplantationmentioning

confidence: 68%

“…Patients implanted with a LVAD on status 1A because of device complications or a 30-day elective grace period or on Status 1B will be priority to receive the organ unless they are deemed nontransplantation candidate (Status 7). It has been reported that approximately more than 50% patients were in Status 1A, and one-half patients had LVAD with in Status 1A (70%) or 1B (30%) at the time of HTx; whereas one-third of the patients in Status 1A had LVAD, of which 50% had device complications, and one-fifth patients in Status 1B had LVAD [89]. E a r l y( < 3 0d a y s )m o r t a l i t yr a n g e sf r o m5 %t o 10% usually due to primary graft failure (35.3%), multiple organ failure (21.6%), and infection (14.3%); and 1-, 2-, 3-, 4-, 5-, 10-, and 15-year cumulative survival rates are 82, 78, 75, 72.5, 69.5, 52, and 34.4%, respectively [88].…”

Section: Cardiac Transplantationmentioning

confidence: 99%

Invasive Treatment in Advanced (Stage-D) Heart Failure

Kırali¹,

Yerlikhan²,

Hançer³

2017

Cardiomyopathies - Types and Treatments

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Heart failure is a complex, true pandemic clinical syndrome and is responsible for 5% of hospitalizations globally. Severe heart failure can manifest as two lethal clinical entities: (1) acute cardiac decompensation with cardiogenic shock after large acute myocardial infarction with mortality rates approaching 50% or after cardiac surgery with mortality rates higher than 65% and (2) chronic destructive cardiac remodeling or acute decompensative exacerbations of cardiomyopathies with one-year mortality of approximately 80% (worse than most types of cancer). Interventional therapies aim first to improve symptoms and life expectancy in patients with severe heart failure syndrome, second to prevent left ventricular remodeling, and third to bridge patients to long-term mechanical circulatory support or transplantation. Several treatment options can be used to stabilize patients. In particular, new percutaneous mitral valve interventions and short-term circulatory support devices open up a new temporary treatment area in symptomatic Stage-D heart failure. The durable or curable surgical destination treatment will be only permanent ventricular assist devices or heart transplantation. This chapter focuses on the treatment steps and new approaches in hospitalized Stage-D heart failure patients.Keywords: heart failure, heart transplantation, ventricular assist device, ECMO, ECLS At end-stage, any type of cardiomyopathy (CMP) causes a complex clinical heart failure (HF) syndrome, which results from structural and/or functional impairment of ventricular filling or ejection. This dire clinical situation can cause an adverse vicious cycle that is ultimately fatal if not treated by pharmacological or invasive mechanical support or heart transplantation (HTx). Left ventricular functional abnormalities range from normal-sized left ventricle (LV) with preserved left ventricular ejection fraction (LVEF) to severe left ventricular dilatation (LVD) with markedly reduced LVEF. Reduced LVEF is defined as the clinical diagnosis of HF and LVEF ≤40%, which means a clinic and functional association of systolic and/or diastolic LVD.© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Abnormal systolic and/or diastolic functions impair left ventricular contractile and relaxation functions that result in increasing left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV), as well as left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD), with the alteration of the left ventricular shape from conical form to spherical form. Adverse elevation of preload and afterload results in increasing left ventricular end-diastolic pressure (LVEDP) and left ventricular end-systolic pressure (LVESP). Inadequate unloading is the pr...

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“…[1][2][3] Patients with CF-LVADs have superior waitlist survival and rates of transplantation when compared with patients supported with surgically implanted temporary left ventricular assist devices (T-LVAD), with and without temporary right ventricular assist devices (T-RVAD). 4,5 To create equitable access to donor organs for the highest mortality patients, the Organ Procurement and Transplantation Network in association with the United Network for Organ Sharing (UNOS) updated the cardiac transplant allocation system in October 2018. 6 Under the new policy, patients with surgically implanted biventricular support receive the highest priority status supported with a CF-LVAD or T-LVAD.…”

Section: Introductionmentioning

confidence: 99%

“…The number of patients listed for an orthotopic heart transplant (OHT) has increased over the past decade due to the rising incidence of refractory heart failure as well as increased survival in patients supported with durable continuous‐flow left ventricular assist devices (CF‐LVADs) 1–3 . Patients with CF‐LVADs have superior waitlist survival and rates of transplantation when compared with patients supported with surgically implanted temporary left ventricular assist devices (T‐LVAD), with and without temporary right ventricular assist devices (T‐RVAD) 4,5 . To create equitable access to donor organs for the highest mortality patients, the Organ Procurement and Transplantation Network in association with the United Network for Organ Sharing (UNOS) updated the cardiac transplant allocation system in October 2018 6 .…”

Section: Introductionmentioning

confidence: 99%

Temporary left ventricular assist devices as a bridge to heart transplantation

et al. 2020

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Background To create equitable access to donor organs for the highest mortality patients, the cardiac transplant allocation system now prioritizes patients with surgically implanted temporary left ventricular assist devices (T‐LVADs). The outcomes following a direct bridge from a T‐LVAD to orthotopic heart transplant (OHT) are not well delineated. Aim This study investigates the T‐LVAD waitlist outcomes and compares the posttransplant outcomes in patients bridged to OHT with surgically implanted T‐LVADs to patients bridged with durable continuous‐flow left ventricular assist devices (CF‐LVADs). Methods Adults recorded in the United Network for Organ Sharing registry bridged to OHT with a durable CF‐LVAD and T‐LVADs, with or without temporary right ventricular assist devices (T‐RVADs), between 2010 and 2018 were included. Propensity matching and multivariable Cox regression were utilized to compare outcomes. Results Of 504 patients waitlisted with T‐LVADs, the majority were transplanted (50%), bridged to CF‐LVAD (17%), or recovered (9%). A total of 9047 recipients were bridged to OHT during the study period with 8875 CF‐LVADs and 172 T‐LVADs. Early survival in propensity‐matched T‐LVAD ± T‐RVAD patients was similar to CF‐LVAD ± T‐RVAD patients but reduced at a 1‐year follow‐up. This difference in survival at 1‐year follow‐up was attributable to significantly reduced survival in patients with combined T‐LVAD + T‐RVAD support when compared with CF‐LVAD, isolated T‐LVAD and combined CF‐LVAD + T‐RVAD support (80% vs 90% vs 90% vs 91%; P = .005). Conclusions This study demonstrates that most patients waitlisted with a T‐LVAD are successfully bridged to durable therapy or recover, and those bridged to OHT have acceptable posttransplant outcomes, particularly when T‐RVADs are not required.

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Differences in Status 1A Heart Transplantation Survival in the Continuous Flow Left Ventricular Assist Device Era

Cited by 11 publications

References 18 publications

Direct bridging to cardiac transplantation with the surgically implanted Impella 5.0 device

Direct bridging to cardiac transplantation with the surgically implanted Impella 5.0 device

Invasive Treatment in Advanced (Stage-D) Heart Failure

Temporary left ventricular assist devices as a bridge to heart transplantation

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