The Effect of Ventricular Assist Devices on Post-Transplant Mortality

Patlolla, Vishnu; Patten, Richard D.; DeNofrio, David; Konstam, Marvin A.; Krishnamani, Rajan

doi:10.1016/j.jacc.2008.08.070

Cited by 94 publications

(24 citation statements)

References 23 publications

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“…17 These findings contrast with those from a recent United Network for Organ Sharing Thoracic Registry analysis that reported higher mortality within 6 months and Ͼ5 years after transplantation in patients previously supported with extracorporeal and, although to a lesser extent, intracorporeal VADs. 18 Post-transplant survival in the present series was not influenced by the type of device used to provide biventricular support. However, there was a trend toward improved post-transplant survival in patients supported for 30 to 90 days compared with those undergoing short term (Ͻ30 days) or long term (Ͼ90 days) support (p ϭ 0.07).…”

Section: Discussionmentioning

confidence: 46%

Survival after biventricular mechanical circulatory support: Does the type of device matter?

Kirsch

Mazzucotelli

Roussel

et al. 2012

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 46%

Survival after biventricular mechanical circulatory support: Does the type of device matter?

Kirsch

Mazzucotelli

Roussel

et al. 2012

The Journal of Heart and Lung Transplantation

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“…2 Their study may have been limited by incomplete LVAD data, however. In contrast, Russo and colleagues examined the UNOS database from 2001–2006 to determine if patients bridged to OHT had worse outcomes than patients undergoing conventional OHT.…”

Section: Resultsmentioning

confidence: 99%

“…There were early concerns that BTT patients would have inferior posttransplant survival compared with conventional OHT. 1, 2 However, contemporary devices have smaller profiles and improved reliability. 3 In the modern era of continuous flow (CF) devices, several reports suggest that patients bridged to transplant with CF LVADs appear to have equivalent or modestly inferior post-transplant survival compared to conventional OHT.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Early Death in Patients Bridged to Transplant With Continuous-Flow Left Ventricular Assist Devices

Arnaoutakis

George

Kilic

et al. 2012

The Annals of Thoracic Surgery

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Background Recent evidence suggests patients bridged to heart transplant (BTT) have equivalent outcomes as those undergoing conventional heart transplantation (OHT). However, there are limited data on risk factors for early mortality in BTT patients. Methods We retrospectively reviewed the United Network for Organ Sharing (UNOS) database of all patients bridged to OHT with a HeartmateII (HMII) from 1/2005–12/2010. The primary outcome was all-cause 90-day mortality. Additional postoperative outcomes were cerebrovascular accident (CVA) and need for renal replacement therapy (RRT). Kaplan-Meier analysis assessed survival. Preoperative variables associated with 90-day mortality on univariate analysis (p<0.2) were included in a multivariable Cox proportional hazards regression. Results 1,312 patients were bridged to OHT with a HMII. During the study, 171 (13.0%%) patients died, and the unadjusted 90-day survival was 92.3%. Average age was 52±12 years, and the most common indication for OHT was idiopathic cardiomyopathy (N=665, 50.7%). Examining center volume for BTT recipients only, the highest annual average center volume in this cohort was 28 BTT procedures per year. Twenty-nine (2.2%) patients sustained a postoperative CVA and 106 (8.3%) required RRT. Cox regression revealed age, glomerular filtration rate, African-American race, human leukocyte antigen mismatch, serum bilirubin, need for mechanical ventilation, donor age, and prolonged ischemia time were associated with 90-day mortality. There was improved early mortality for patients transplanted at high volume centers (p=0.01). Conclusions This is the largest modern study to examine risk factors for early mortality in patients bridged to OHT, and the first to use UNOS data. With increasing use of HMII mechanical assistance to bridge patients to OHT, these findings will aid in identifying patients best suited to benefit from this therapy.

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“…Survival post transplant in device patients has been the subject of several reports as multivariate analysis of large registry data has suggested that mechanical support is a predictive factor for poor transplant survival (12). More recent reports, which focused exclusively on long-term left ventricular assist device use as a bridge to transplant has refuted these observations (13,14).…”

Section: Discussionmentioning

confidence: 99%

Impact of long term left ventricular assist device therapy on donor allocation in cardiac transplantation

Uriel

Jorde²,

Pak

et al. 2013

The Journal of Heart and Lung Transplantation

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Objective To study the effect of organ allocation system in the era of continuous flow pumps. Background Left Ventricular Assist Devices (LVAD) are increasingly used as a bridge to transplant (BTT) for patients with advanced congestive heart failure (CHF) and are assigned United Network for Organ Sharing (UNOS) high priority status (1B or 1A). Methods A retrospective chart review was performed of all patients transplanted between 1/2001–1/2011 at Columbia University Medical Center. Results 726 adult heart transplantations were performed. 274 BTT patients were implanted with LVAD; of which 227 patients were transplanted. 63 patients were transplanted as UNOS-1B, while 164 were transplanted as UNOS-1A (72%). Of these 164 patients, 65 were transplanted during their 30-day 1A period (43%) and 96 after upgrading to UNOS-1A for device complication (56%). For 452 non-device patients 139 (31%) were transplanted as UNOS-1A, 233 as UNOS-1B (52%), and 80 as UNOS-2 (17%). The percentage of patients bridged with LVAD increased from 19% in 2001 to 64% in 2010 while the number transplanted during their 30 day 1A grace period declined from 57% in 2005 to 16% in 2011; i.e. 84% of BTT patients in 2011 needed more than 30 days 1A time to be transplanted. Most LVAD patients are now transplanted while suffering device complication. There was no difference in post transplant survival between LVAD patients transplanted as UNOS 1B, 1A grace period or for a device complication Conclusions As wait time for cardiac transplantation increased the percentage of patients being bridged to transplant with an LVAD has increased with the majority of them transplanted in the setting of device complication.

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The Effect of Ventricular Assist Devices on Post-Transplant Mortality

Cited by 94 publications

References 23 publications

Survival after biventricular mechanical circulatory support: Does the type of device matter?

Survival after biventricular mechanical circulatory support: Does the type of device matter?

Risk Factors for Early Death in Patients Bridged to Transplant With Continuous-Flow Left Ventricular Assist Devices

Impact of long term left ventricular assist device therapy on donor allocation in cardiac transplantation

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