Mechanical Circulatory Support Device Utilization and Heart Transplant Waitlist Outcomes in Patients With Restrictive and Hypertrophic Cardiomyopathy

Sridharan, Lakshmi; Wayda, Brian; Truby, Lauren K.; Latif, F.; Restaino, Susan; Takeda, Koji; Takayama, Hiroo; Naka, Yoshifumi; Colombo, P.C.; Maurer, Mathew S.; Farr, Maryjane; Topkara, V.K.

doi:10.1161/circheartfailure.117.004665

Cited by 30 publications

(14 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…End‐stage heart failure (HF) patients with the underlying diagnosis of restrictive (RCM) and hypertrophic cardiomyopathy (HCM) represent approximately 5% of patients listed for heart transplantation (HT) 1 . These patients historically have a higher mortality on the HT list and were more often delisted due to worsening clinical status when compared with other cardiomyopathies 2–4 .…”

Section: Introductionmentioning

confidence: 99%

“…These patients historically have a higher mortality on the HT list and were more often delisted due to worsening clinical status when compared with other cardiomyopathies 2–4 . This patient population has limited benefit from durable mechanical circulatory support (MCS) devices and they are therefore infrequently used, 1 with a reported 1‐year survival of 64% after left ventricular assist device (LVAD) implantation 5 compared to 82% survival for an unselected LVAD population 6 . Survival after HT for RCM/HCM patients, however, is comparable to overall post‐HT survival, and waitlist registration for RCM/HCM indications has been increasing significantly relative to other cardiomyopathies 4 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Changes in heart transplant waitlist and posttransplant outcomes in patients with restrictive and hypertrophic cardiomyopathy with the new heart transplant allocation system

Loyaga‐Rendon

Fermin

Jani

et al. 2021

American Journal of Transplantation

View full text Add to dashboard Cite

Historically, patients with restrictive (RCM) and hypertrophic cardiomyopathy (HCM) experienced longer wait‐times for heart transplant (HT) and increased waitlist mortality. Recently, a new HT allocation system was implemented in the United States. We sought to determine the impact of the new HT system on RCM/HCM patients. Adult patients with RCM/HCM listed for HT between November 2015 and September 2019 were identified from the UNOS database. Patients were stratified into two groups: old system and new system. We identified 872 patients who met inclusion criteria. Of these, 608 and 264 were classified in the old and new system groups, respectively. The time in the waitlist was shorter (25 vs. 54 days, P < .001), with an increased frequency of HT in the new system (74% vs. 68%, P = .024). Patients who were transplanted in the new system had a longer ischemic time, increased use of temporary mechanical circulatory support and mechanical ventilation. There was no difference in posttransplant survival at 9 months (91.1% vs. 88.9%) (p = .4). We conclude that patients with RCM/HCM have benefited from the new HT allocation system, with increased access to HT without affecting short‐term posttransplant survival.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Changes in heart transplant waitlist and posttransplant outcomes in patients with restrictive and hypertrophic cardiomyopathy with the new heart transplant allocation system

Loyaga‐Rendon

Fermin

Jani

et al. 2021

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…In addition, the increased waitlist mortality and delisting observed among INTERMACS profile I-II patients aligns with previous studies that have demonstrated an association between hemodynamic deterioration requiring inotrope use and mortality on the HTx waitlist. 17,18 Recent work has also indicated that the use of VAD as BTT is associated with a lower waitlist mortality in critically decompensated heart transplant candidates. 19 This fits with the observation in the current study that VAD implantation significantly improves waitlist survival in patients profiled as INTERMACS I-II.…”

Section: Relation To Previous Workmentioning

confidence: 99%

Utility of the INTERMACS profile at the time of assessment for heart transplant

Friesen

Foroutan

Krakovsky

et al. 2020

Clinical Transplantation

View full text Add to dashboard Cite

The Interagency Registry of Mechanically Assisted Circulatory Support (INTERMACS) profiles are associated with mortality in heart failure patients undergoing ventricular assist device (VAD) implantation and heart transplantation (HTx). We assessed the prognostic value of the INTERMACS profile at the time of assessment for HTx or durable VAD implantation as bridge to candidacy (BTC). A total of 503 consecutive patients considered for HTx or VAD between 2006 and 2016 were included. The associations between INTERMACS profile and (a) waitlist mortality or delisting, (b) probability of HTx, and (c) overall mortality or delisting were evaluated using multivariable analysis. Median follow‐up time was 2.9 years (IQR: 0.9‐5.5) during which 184 received VAD, 347 received HTx, and 73 died (27 waitlist, 46 post‐transplant). INTERMACS I‐II profile was associated with higher waitlist mortality or delisting (HR: 3.83, 95% CI: 1.22‐12.03), and this risk was reversed by VAD implantation (HR: 0.12, 95% CI: 0.03‐0.50). INTERMACS III‐IV profile was associated with a higher probability of HTx (HR: 1.82, 95% CI: 1.37‐2.40). INTERMACS profile was not associated with the composite outcome of overall mortality or delisting. These results emphasize the prognostic utility of INTERMACS at time of decision for advanced therapies and its potential value in selecting patients for different interventions.

show abstract

“…Status 2 patients were those on oral medications and considered low urgency for HT. This 3‐tier system did not adequately account for the needs of patients who are often less tolerant of inotropes or those with cardiomyopathies structurally incompatible with left ventricular assist devices or other MCS, 3–7 such as patients with infiltrative, hypertrophic, and restrictive cardiomyopathies. With this allocation system, status exceptions were needed to upgrade listing status for these individuals, in the event of clinical deterioration.…”

Section: Introductionmentioning

confidence: 99%

Comparing outcomes for infiltrative and restrictive cardiomyopathies under the new heart transplant allocation system

Griffin

DeFilippis

Rosenblum

et al. 2020

Clinical Transplantation

Self Cite

View full text Add to dashboard Cite

Heart transplant (HT) allocation for patients with infiltrative, hypertrophic, and restrictive cardiomyopathies has been debated extensively, particularly during the development of the recent Organ Procurement and Transplant Network (OPTN) heart allocation policy. 1 Historically, under the three-tier system (Status 1A, 1B and Status 2) which came into effect on January 19th, 1999, patients were allocated based on the level of support they required. 2 Status 1A necessitated intensive care unit level support with intravenous medication, continuous hemodynamic monitoring, mechanical ventilation, and/or mechanical circulatory support (MCS). Patients designated as Status 1B had intermediate level urgency for HT and were either in the hospital or at home on inotropic agents. Status 2 patients were those on oral medications and considered low urgency for HT. This 3-tier system did not adequately account for the

show abstract

Mechanical Circulatory Support Device Utilization and Heart Transplant Waitlist Outcomes in Patients With Restrictive and Hypertrophic Cardiomyopathy

Cited by 30 publications

References 53 publications

Changes in heart transplant waitlist and posttransplant outcomes in patients with restrictive and hypertrophic cardiomyopathy with the new heart transplant allocation system

Changes in heart transplant waitlist and posttransplant outcomes in patients with restrictive and hypertrophic cardiomyopathy with the new heart transplant allocation system

Utility of the INTERMACS profile at the time of assessment for heart transplant

Comparing outcomes for infiltrative and restrictive cardiomyopathies under the new heart transplant allocation system

Contact Info

Product

Resources

About