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Bruce MR, Frasco PE, Sell-Dottin KA, Cuevas CV, Chang YHH, Lim ES, Rosenthal JL, DeValeria PA, Smith BB. Days Alive and Out of the Hospital After Heart Transplantation: A Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2024; 38:93-100. [PMID: 38197788 DOI: 10.1053/j.jvca.2023.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/04/2023] [Accepted: 09/26/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Evaluate days alive and out of the hospital (DAOH) as an outcome measure after orthotopic heart transplantation in patients with mechanical circulatory support (MCS) as a bridge to transplant compared to those patients without prior MCS. DESIGN A retrospective observational study of adult patients who underwent cardiac transplantation between January 1, 2015, and January 1, 2020. The primary outcome was DAOH at 365 days (DAOH365) after an orthotopic heart transplant. A Poisson regression model was fitted to detect the association between independent variables and DAOH365. SETTING An academic tertiary referral center. PARTICIPANTS A total of 235 heart transplant patients were included-103 MCS as a bridge to transplant patients, and 132 direct orthotopic heart transplants without prior MCS. MEASUREMENTS AND MAIN RESULTS The median DAOH365 for the entire cohort was 348 days (IQR 335.0-354.0). There was no difference in DAOH365 between the MCS patients and patients without MCS (347.0 days [IQR 336.0-353.0] v 348.0 days [IQR 334.0-354.0], p = 0.43). Multivariate analysis identified patients who underwent a transplant after the 2018 heart transplant allocation change, pretransplant pulmonary hypertension, and increased total ischemic time as predictors of reduced DAOH365. CONCLUSIONS In this analysis of patients undergoing orthotopic heart transplantation, there was no significant difference in DAOH365 in patients with prior MCS as a bridge to transplant compared to those without MCS. Incorporating days alive and out of the hospital into the pre-transplant evaluation may improve understanding and conceptualization of the post-transplantation patient experience and aid in shared decision-making with clinicians.
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Affiliation(s)
- Marcus R Bruce
- Department of Anesthesiology and Perioperative Medicine, Cardiothoracic Division, University of California San Diego, San Diego, CA
| | - Peter E Frasco
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ
| | | | | | - Yu-Hui H Chang
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
| | - Elisabeth S Lim
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ
| | | | | | - Bradford B Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ.
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2
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Siddiqi HK, Trahanas J, Xu M, Wells Q, Farber-Eger E, Pasrija C, Amancherla K, Debose-Scarlett A, Brinkley DM, Lindenfeld J, Menachem JN, Ooi H, Pedrotty D, Punnoose L, Rali AS, Sacks S, Wigger M, Zalawadiya S, McMaster W, Devries S, Shah A, Schlendorf K. Outcomes of Heart Transplant Donation After Circulatory Death. J Am Coll Cardiol 2023; 82:1512-1520. [PMID: 37793748 DOI: 10.1016/j.jacc.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Heart transplantation using donation after circulatory death (DCD) allografts is increasingly common, expanding the donor pool and reducing transplant wait times. However, data remain limited on clinical outcomes. OBJECTIVES We sought to compare 6-month and 1-year clinical outcomes between recipients of DCD hearts, most of them recovered with the use of normothermic regional perfusion (NRP), and recipients of donation after brain death (DBD) hearts. METHODS We conducted a single-center retrospective observational study of all adult heart-only transplants from January 2020 to January 2023. Recipient and donor data were abstracted from medical records and the United Network for Organ Sharing registry, respectively. Survival analysis and Cox regression were used to compare the groups. RESULTS During the study period, 385 adults (median age 57.4 years [IQR: 48.0-63.7 years]) underwent heart-only transplantation, including 122 (32%) from DCD donors, 83% of which were recovered with the use of NRP. DCD donors were younger and had fewer comorbidities than DBD donors. DCD recipients were less often hospitalized before transplantation and less likely to require pretransplantation temporary mechanical circulatory support compared with DBD recipients. There were no significant differences between groups in 1-year survival, incidence of severe primary graft dysfunction, treated rejection during the first year, or likelihood of cardiac allograft vasculopathy at 1 year after transplantation. CONCLUSIONS In the largest single-center comparison of DCD and DBD heart transplantations to date, outcomes among DCD recipients are noninferior to those of DBD recipients. This study adds to the published data supporting DCD donors as a safe means to expand the heart donor pool.
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Affiliation(s)
- Hasan K Siddiqi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - John Trahanas
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Meng Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Quinn Wells
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Farber-Eger
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chetan Pasrija
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kaushik Amancherla
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexandra Debose-Scarlett
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - D Marshall Brinkley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - JoAnn Lindenfeld
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan N Menachem
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Henry Ooi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Dawn Pedrotty
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Lynn Punnoose
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aniket S Rali
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Suzanne Sacks
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark Wigger
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Sandip Zalawadiya
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William McMaster
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven Devries
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashish Shah
- Department of Cardiothoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelly Schlendorf
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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3
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Trasplante cardíaco en pacientes portadores de asistencia ventricular izquierda de larga duración: «trucos y consejos». CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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4
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Zhang B, Guo S, Ning J, Li Y, Liu Z. Continuous-flow left ventricular assist device versus orthotopic heart transplantation in adults with heart failure: a systematic review and meta-analysis. Ann Cardiothorac Surg 2021; 10:209-220. [PMID: 33842215 DOI: 10.21037/acs-2020-cfmcs-fs-197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Due to the lack of donor hearts, many studies have assessed the prognosis of heart failure (HF) patients treated with a continuous-flow left ventricular assist device (CF-LVAD). However, previous results have not been consistent and minimal data is available regarding long-term outcomes. There is no consensus on whether CF-LVAD as a bridge or destination therapy (DT) can equal orthotopic heart transplantation (HTx). The purpose of our study is to compare clinical outcomes between CF-LVAD and HTx in adults. Methods We searched controlled trials from PubMed, Cochrane Library, and Embase databases until July 1, 2020. The mortality at different time points and adverse events were analyzed among 12 included studies. Results No significant differences were found in mortality at one-year [odds ratio (OR) =1.08; 95% CI: 0.97-1.21], two-year (OR =1.01; 95% CI: 0.91-1.12), three-year (OR =1.02; 95% CI: 0.69-1.51), and five-year (OR =1.02; 95% CI: 0.93-1.11), as well as the comparison of stroke, bleeding, and infection between CF-LVAD as a bridge versus HTx. The pooled analysis of one-year mortality (OR =2.76; 95% CI: 0.38-20.18) and two-year mortality (OR =1.64; 95% CI: 0.22-12.23) revealed no significant difference between CF-LVAD DT and HTx. Comparisons of adverse events showed no differences in bleeding or infection, but a higher risk of stroke (OR =5.09; 95% CI: 1.74-14.84) for patients treated with CF-LVAD DT than with HTx. Conclusions CF-LVAD as a bridge results in similar outcomes as HTx within five years. CF-LVAD as a DT is associated with similar one-year and two-year mortality, but carries a higher risk of stroke, as compared with HTx.
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Affiliation(s)
- Bufan Zhang
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China
| | - Shaohua Guo
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jie Ning
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiai Li
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Zhigang Liu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China.,Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
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5
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Kaliyev R, Lesbekov T, Bekbossynov S, Nurmykhametova Z, Bekbossynova M, Novikova S, Medressova A, Smagulov N, Faizov L, Samalavicius R, Pya Y. Heart transplantation of patients with ventricular assist devices: impact of normothermic ex-vivo preservation using organ care system compared with cold storage. J Cardiothorac Surg 2020; 15:323. [PMID: 33109229 PMCID: PMC7590799 DOI: 10.1186/s13019-020-01367-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/18/2020] [Indexed: 01/09/2023] Open
Abstract
Background Organ Care System (OCS) minimizes the cold ischemic time and allows for optimization of logistics and meticulous recipient preparation. Impact of normothermic ex-vivo preservation using OCS compared with cold storage (CS) for prolonged heart preservation especially beneficial for high-risk recipients bridged to transplantation with Mechanical Circulatory Support (MCS). Methods Between 2012 and 2018, we performed a retrospective single-center review of prospectively collected data. All patients who underwent heart transplantation with MCS using the OCS Heart (n = 25) versus standard cold storage (n = 10) were included in this study. Results During this period, 353 patients were implanted with left ventricular assisted device (LVAD) and 35 (10%) were bridged to heart transplantation. There was no significant difference in donor and recipient characteristics and risk factors. The Index for Mortality Prediction after Cardiac Transplantation (IMPACT) score was a trend towards higher estimated risk of death at 1y in the OCS group (14.2 vs. 10.8% p = 0.083). Mean total ischemic time during preservation was statistically significantly longer in CS vs OCS group (210 (23) Vs 74.6 (13) min p = 0.001). Median ex vivo normothermic heart perfusion time in OCS was 348.4(132; 955) min. There was significant difference in total out of body time between OCS group 423(67) Vs CS group 210(23) min p = 0.002). All patients were alive on the 30th days post implant in CS groups and 96% in OCS group (p = 0.5). Conclusion Normothermic ex-vivo preservation of the allograft during transportation with the organ care system might be beneficial for long-time out of body organ preservation in comparison of cold storage especially for recipients on mechanical circulatory support.
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Affiliation(s)
- Rymbay Kaliyev
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Timur Lesbekov
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Serik Bekbossynov
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | | | | | - Svetlana Novikova
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Assel Medressova
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Nurlan Smagulov
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Linar Faizov
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | | | - Yuriy Pya
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
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6
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Pal N, Gay SH, Boland CG, Lim AC. Heart Transplantation After Ventricular Assist Device Therapy: Benefits, Risks, and Outcomes. Semin Cardiothorac Vasc Anesth 2020; 24:9-23. [DOI: 10.1177/1089253219898985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Heart transplantation is an established treatment for end-stage heart failure. Due to the increase in demand and persistent scarcity of organ, mechanical circulatory devices have played a major role in therapy for advanced heart failure. Usage of left ventricular assist device (LVAD) has gone up from 6% in 2006 to 43% in 2013 as per the United Network of Organ Sharing database. Majority of patients presenting for a heart transplantation are often bridged with an assist device prior for management of heart failure while on wait-list. On one hand, it is well established that LVADs improve survival on wait-list; on the other hand, the effect of LVAD on morbidity and survival after a heart transplantation is still unclear. In this article, we review the available literature and attempt to infer the outcomes given the risks and benefits of heart transplantation with prior LVAD patients.
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Affiliation(s)
- Nirvik Pal
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Aaron C. Lim
- Virginia Commonwealth University, Richmond, VA, USA
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7
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Farrero M, Flores‐Umanzor EJ, Pomar JL, Sagarra J, Santiago E, Perez‐Villa F. Elective or emergency heart transplantation: Cost comparison in a single center. Clin Transplant 2019; 33:e13596. [DOI: 10.1111/ctr.13596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/24/2019] [Accepted: 05/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Marta Farrero
- Cardiology Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Eduardo J. Flores‐Umanzor
- Cardiology Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Jose Luis Pomar
- Cardiovascular Surgery Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Joan Sagarra
- Department of Economics, Respiratory Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Evelyn Santiago
- Cardiology Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Felix Perez‐Villa
- Cardiology Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
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8
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Van Puyvelde J, Rega F, Minami T, Claus P, Cools B, Gewillig M, Meyns B. Creation of the Fontan circulation in sheep: a survival model. Interact Cardiovasc Thorac Surg 2019; 29:15-21. [DOI: 10.1093/icvts/ivz022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/30/2018] [Accepted: 01/13/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joeri Van Puyvelde
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tomoyuki Minami
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Imaging and Dynamics, University Hospitals Leuven, Leuven, Belgium
| | - Bjorn Cools
- Department of Paediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Marc Gewillig
- Department of Paediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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9
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Carrozzini M, Bejko J, Gambino A, Tarzia V, Lanera C, Gregori D, Gerosa G, Bottio T. Results of new-generation intrapericardial continuous flow left ventricular assist devices as a bridge-to-transplant. J Cardiovasc Med (Hagerstown) 2018; 19:739-747. [DOI: 10.2459/jcm.0000000000000721] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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10
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Do Patients Supported With Continuous-flow Left Ventricular Assist Device Have a Sufficient Risk of Death to Justify a Priority Allocation? A Propensity Score Matched Analysis of Patients Listed in UNOS Status 2. Transplantation 2018; 102:e288-e294. [DOI: 10.1097/tp.0000000000002105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Seco M, Zhao DF, Byrom MJ, Wilson MK, Vallely MP, Fraser JF, Bannon PG. Long-term prognosis and cost-effectiveness of left ventricular assist device as bridge to transplantation: A systematic review. Int J Cardiol 2017; 235:22-32. [PMID: 28285802 DOI: 10.1016/j.ijcard.2017.02.137] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND This systematic review aimed to evaluate the clinical outcomes and cost-effectiveness of left ventricular assist devices (LVADs) used as bridge to transplantation (BTT), compared to orthotopic heart transplantation (OHT) without a bridge. METHOD Systematic searches were performed in electronic databases with available data extracted from text and digitized figures. Meta-analysis of short and long-term term post-transplantation outcomes was performed with summation of cost-effectiveness analyses. RESULTS Twenty studies reported clinical outcomes of 4575 patients (1083 LVAD BTT and 3492 OHT). Five studies reported cost-effectiveness data on 837 patients (339 VAD BTT and 498 OHT). There was no difference in long-term post-transplantation survival (HR 1.24, 95% CI 1.00-1.54), acute rejection (HR 1.10, 95% CI 0.93-1.30), or chronic rejection and cardiac allograft vasculopathy (HR 0.99, 95% CI 0.73-1.36). No differences were found in 30-day post-operative mortality (OR 0.91, 95% CI 0.42-2.00), stroke (OR 1.64, 95% CI 0.43-6.27), renal failure (OR 1.43, 95% CI 0.58-3.54), bleeding (OR 1.56, 95% CI 0.78-3.13), or infection (OR 2.44, 95% CI 0.81-7.38). Three of the five studies demonstrated incremental cost-effectiveness ratios below the acceptable maximum threshold. The total cost of VAD BTT ranged from $316,078 to $1,025,500, and OHT ranged from $179,051 to $802,200. CONCLUSION LVADs used as BTT did not significantly alter post-transplantation long-term survival, rejection, and post-operative morbidity. LVAD BTT may be cost-effective, particularly in medium and high-risk patients with expected prolonged waiting times, renal dysfunction, and young patients.
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Affiliation(s)
- Michael Seco
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Dong Fang Zhao
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia
| | - Michael J Byrom
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons, Sydney, Australia
| | - Michael K Wilson
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Michael P Vallely
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Australia
| | - Paul G Bannon
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Heart and Lung Surgeons, Sydney, Australia.
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Gulati G, Ouyang D, Ha R, Banerjee D. Optimal timing of same-admission orthotopic heart transplantation after left ventricular assist device implantation. World J Cardiol 2017; 9:154-161. [PMID: 28289529 PMCID: PMC5329742 DOI: 10.4330/wjc.v9.i2.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/25/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the impact of timing of same-admission orthotopic heart transplant (OHT) after left ventricular assist device (LVAD) implantation on in-hospital mortality and post-transplant length of stay.
METHODS Using data from the Nationwide Inpatient Sample from 1998 to 2011, we identified patients 18 years of age or older who underwent implantation of a LVAD and for whom the procedure date was available. We calculated in-hospital mortality for those patients who underwent OHT during the same admission as a function of time from LVAD to OHT, adjusting for age, sex, race, household income, and number of comorbid diagnoses. Finally, we analyzed the effect of time to OHT after LVAD implantation on the length of hospital stay post-transplant.
RESULTS Two thousand and two hundred patients underwent implantation of a LVAD in this cohort. One hundred and sixty-four (7.5%) patients also underwent OHT during the same admission, which occurred on average 32 d (IQR 7.75-66 d) after LVAD implantation. Of patients who underwent OHT, patients who underwent transplantation within 7 d of LVAD implantation (“early”) experienced increased in-hospital mortality (26.8% vs 12.2%, P = 0.0483) compared to patients who underwent transplant after 8 d (“late”). There was no statistically significant difference in age, sex, race, household income, or number of comorbid diagnoses between the early and late groups. Post-transplant length of stay after LVAD implantation was also not significantly different between patients who underwent early vs late OHT.
CONCLUSION In this cohort of patients who received LVADs, the rate of in-hospital mortality after OHT was lower for patients who underwent late OHT (at least 8 d after LVAD implantation) compared to patients who underwent early OHT. Delayed timing of OHT after LVAD implantation did not correlate with longer hospital stays post-transplant.
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13
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Nestorovic EM, Grupper A, Joyce LD, Milic NM, Stulak JM, Edwards BS, Pereira NL, Daly RC, Kushwaha SS. Effect of Pretransplant Continuous-Flow Left Ventricular Assist Devices on Cellular and Antibody-Mediated Rejection and Subsequent Allograft Outcomes. Am J Cardiol 2017; 119:452-456. [PMID: 27939231 DOI: 10.1016/j.amjcard.2016.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 11/27/2022]
Abstract
The aim of this study was to evaluate the impact of continuous-flow left ventricular assist devices (CF-LVAD) on subsequent rejection after heart transplantation (HT) by using cellular rejection score and antibody-mediated rejection score (AMRS) and correlating with subsequent allograft outcomes. We retrospectively analyzed 108 consecutive patients who underwent HT without (n = 67) or with (n = 41) previous CF-LVAD in 2008 to 2014. The 24 months cumulative effect of rejection was calculated by using cellular rejection scores and AMRS, based on the total number of rejections divided by valid biopsy samples. Vasculopathy was assessed both by routine coronary angiogram and intravascular ultrasound. Patients who underwent pretransplant CF-LVAD demonstrated a significant increase in the number of cellular rejection episodes as compared with the nonbridged patients, for 1 and 2 years of follow-up (p = 0.026 and p = 0.016), respectively. There were no differences in AMRS (p >0.05) and allograft outcomes, such as vasculopathy and overall survival (p >0.05) over the period of follow-up. Implantation of a CF-LVAD before HT impacts cellular rejection during the post-transplant period. Despite these findings, CF-LVAD does not translate to differences in allograft outcomes after transplant, such as vasculopathy and overall survival over the period of the study. In conclusion, whether this affects longer term outcomes than studied remains to be determined.
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Abstract
The prevalence of heart failure has increased in Asia. A significant proportion of patients with heart failure and left ventricular dysfunction end up with advanced heart failure or end-stage heart disease. These patients may be placed on the waiting list for heart transplant. There are more than 10 countries in Asia that have an active heart transplant program. The number of heart transplants performed is limited despite an increase in the number of patients with end-stage heart failure mainly because of donor shortage, which may be related to religious belief and inefficient allocation policy.
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Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
| | - Aekarach Ariyachaipanich
- Excellent Center for Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Patumwan, Bangkok 10330, Thailand; Division of Cardiology, Department of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Patumwan, Bangkok 10330, Thailand
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15
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Fischer TH, Kleinwächter A, Herting J, Eiringhaus J, Hartmann N, Renner A, Gummert J, Haverich A, Schmitto JD, Sossalla S. Inhibition of CaMKII Attenuates Progressing Disruption of Ca2+Homeostasis Upon Left Ventricular Assist Device Implantation in Human Heart Failure. Artif Organs 2016; 40:719-26. [DOI: 10.1111/aor.12677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Thomas H. Fischer
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
- German Center for Cardiovascular Research (DZHK); Göttingen Germany
| | - Astrid Kleinwächter
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
| | - Jonas Herting
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
- German Center for Cardiovascular Research (DZHK); Göttingen Germany
| | - Jörg Eiringhaus
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
| | - Nico Hartmann
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
- German Center for Cardiovascular Research (DZHK); Göttingen Germany
| | - André Renner
- Department for Heart and Transplantation Surgery; Heart Center; Bad Oeynhausen Germany
| | - Jan Gummert
- Department for Heart and Transplantation Surgery; Heart Center; Bad Oeynhausen Germany
| | - Axel Haverich
- Department for Thoracic and Heart Surgery; Medical University of Hannover; Hannover Germany
| | - Jan D. Schmitto
- Department for Thoracic and Heart Surgery; Medical University of Hannover; Hannover Germany
| | - Samuel Sossalla
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
- German Center for Cardiovascular Research (DZHK); Göttingen Germany
- Department for Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine; University Medical Center; Kiel Germany
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16
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Matsumoto Y, Shibata SC, Maeda A, Yoshioka D, Kamibayashi T, Uchiyama A, Sawa Y, Fujino Y. Early postoperative management of heart transplant recipients with current ventricular assist device support in Japan: experience from a single center. J Anesth 2015; 29:868-73. [PMID: 26162779 DOI: 10.1007/s00540-015-2044-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study reviews our experience with the perioperative management of heart transplant (HT) recipients and explores how prior ventricular assist device (VAD) support affects the requirements for postoperative mechanical ventilation and circulatory support. METHODS AND RESULTS A retrospective database review was performed from 2007 to 2014. Early postoperative outcomes were compared between VAD and non-VAD groups. Forty-four patients were studied. The mean age was 38 ± 13 years, 30% were female, and 88% experienced non-ischemic heart failure. Forty patients (91%) required VAD support at the time of HT, with a mean duration of 864 ± 351 days. The median postoperative mechanical ventilation times in the VAD and non-VAD groups were 54 [95% confidence interval (CI) 42.9-297.3] and 15 (95% CI 4.8-30.0; p = 0.0199) hours, respectively. The VAD group experienced increased bleeding during the first 48 h after HT (6.7 ± 3.5 vs. 1.8 ± 0.75 l, p = 0.004). Mechanical circulatory support with intra-aortic balloon pumping or venoarterial extracorporeal membrane oxygenation was required in 30% of VAD group patients. Increased bleeding and primary graft failure were the main causes of prolonged mechanical ventilation. CONCLUSIONS HT recipients with VAD support required longer mechanical ventilation periods and mechanical circulatory support in the postoperative period.
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Affiliation(s)
- Yu Matsumoto
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Sho C Shibata
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Akihiko Maeda
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka, Japan
| | - Takahiko Kamibayashi
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Akinori Uchiyama
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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17
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Pozzi M, Giraud R, Tozzi P, Bendjelid K, Robin J, Meyer P, Obadia JF, Banfi C. Long-term continuous-flow left ventricular assist devices (LVAD) as bridge to heart transplantation. J Thorac Dis 2015; 7:532-42. [PMID: 25922736 DOI: 10.3978/j.issn.2072-1439.2015.01.45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 11/12/2014] [Indexed: 12/24/2022]
Abstract
Heart transplantation (HTx) is the treatment of choice for end-stage heart failure but the limited availability of heart's donors still represents a major issue. So long-term mechanical circulatory support (MCS) has been proposed as an alternative treatment option to assist patients scheduled on HTx waiting list bridging them for a variable time period to cardiac transplantation-the so-called bridge-to-transplantation (BTT) strategy. Nowadays approximately 90% of patients being considered for MCS receive a left ventricular assist device (LVAD). In fact, LVAD experienced several improvements in the last decade and the predominance of continuous-flow over pulsatile-flow technology has been evident since 2008. The aim of the present report is to give an overview of continuous-flow LVAD utilization in the specific setting of the BTT strategy taking into consideration the most representative articles of the scientific literature and focusing the attention on the evolution, clinical outcomes, relevant implications on the HTx strategy and future perspectives of the continuous-flow LVAD technology.
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Affiliation(s)
- Matteo Pozzi
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Raphaël Giraud
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Piergiorgio Tozzi
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Karim Bendjelid
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Jacques Robin
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Philippe Meyer
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Jean François Obadia
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Carlo Banfi
- 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Hospices Civils de Lyon, "Claude Bernard" University, Lyon, France ; 2 Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland ; 3 Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland ; 4 Division of Cardiology, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland ; 5 Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
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18
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García Sáez D, Zych B, Sabashnikov A, Bowles CT, De Robertis F, Mohite PN, Popov AF, Maunz O, Patil NP, Weymann A, Pitt T, McBrearty L, Pates B, Hards R, Amrani M, Bahrami T, Banner NR, Simon AR. Evaluation of the Organ Care System in Heart Transplantation With an Adverse Donor/Recipient Profile. Ann Thorac Surg 2014; 98:2099-105; discussion 2105-6. [DOI: 10.1016/j.athoracsur.2014.06.098] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/23/2014] [Accepted: 06/02/2014] [Indexed: 10/24/2022]
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19
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Late right heart failure during support with continuous-flow left ventricular assist devices adversely affects post-transplant outcome. J Heart Lung Transplant 2014; 34:667-74. [PMID: 25577566 DOI: 10.1016/j.healun.2014.10.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 09/22/2014] [Accepted: 10/29/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Right heart failure (RHF) is an unresolved issue during continuous-flow left ventricular assist device (LVAD) support. Little is known about post-transplant outcomes in patients complicated by late RHF during LVAD support. METHODS Between May 2004 and December 2013, 141 patients underwent cardiac transplantation after isolated LVAD bridging at our center. Late RHF was defined as heart failure requiring medical intervention >4 weeks after LVAD implantation. RESULTS The patients' mean age was 53 ± 13 years, 82% were men, and 36% had an ischemic etiology. The mean duration of LVAD support before transplantation was 0.75 years. Late RHF developed in 21 patients (15%) during LVAD support. Of these patients, 11 were supported with inotropic agents at the time of transplantation. Patients with RHF had higher creatinine (1.6 ± 0.88 mg/dL vs 1.3 ± 0.67 mg/dL, p = 0.07), higher blood urea nitrogen (32 ± 17 mg/dL vs 24 ± 10 mg/dL, p = 0.0013), higher total bilirubin (0.96 ± 0.46 mg/dL vs 0.78 ± 0.42 mg/dL, p = 0.07), and lower albumin (3.8 ± 0.60 g/dL vs 4.1 ± 0.46 g/dL, p = 0.0019) at the time of transplantation compared with patients who did not develop RHF. In-hospital mortality was significantly higher in patients with late RHF during LVAD support (29% vs 6.7%, p = 0.002). Overall post-transplant survival rates were 87% at 1 year, 83% at 3 years, and 77% at 5 years. The 5-year post-transplant survival was significantly worse in patients who developed late RHF during LVAD support compared with survival in patients who did not develop RHF (26% vs 87%, p < 0.0001). CONCLUSIONS Late RHF during LVAD support adversely affects post-transplant survival.
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20
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Takeda K, Takayama H, Kalesan B, Uriel N, Colombo PC, Jorde UP, Yuzefpolskaya M, Mancini DM, Naka Y. Outcome of cardiac transplantation in patients requiring prolonged continuous-flow left ventricular assist device support. J Heart Lung Transplant 2014; 34:89-99. [PMID: 25444372 DOI: 10.1016/j.healun.2014.09.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/20/2014] [Accepted: 09/03/2014] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study assessed the early and late outcomes after cardiac transplantation in patients receiving long-term continuous-flow left ventricular assist device (CF-LVAD) support. METHODS Between April 2004 and September 2013, 192 patients underwent HeartMate II (Thoratec, Pleasanton, CA) CF-LVAD placement as a bridge to transplant at our center. Of these, 122 (63%) successfully bridged patients were retrospectively reviewed. Patients were stratified into 2 groups according to their waiting time with CF-LVAD support of <1 year or ≥1 year. RESULTS The study cohort was a mean age of 54 ± 13 years, 79% were male, and 35% had an ischemic etiology. The mean duration of CF-LVAD support before transplantation was 296 days (range, 27-1,413 days). The overall 30-day mortality was 4.1%. Overall post-transplant survival was 88%, 84%, 78% at 1, 3, and 5 years, respectively. The 32 patients (26%) with ≥1 year of CF-LVAD support (mean, 635 days) were more likely to have blood type O, a larger body size, and to have been readmitted due to recurrent heart failure and device failure requiring exchange than those with <1 year of CF-LVAD support. Patients who required prolonged support time also had worse in-hospital mortality (16% vs 6.7%, p = 0.12) and significantly lower survival at 3 years after transplantation (68% vs 88%, p = 0.049). CONCLUSIONS The overall short-term and long-term cardiac transplant outcomes of patients supported with CF-LVAD are satisfactory. However, patients who require prolonged CF-LVAD support may have diminished post-transplant survival due to adverse events occurring during device support.
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Affiliation(s)
- Koji Takeda
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Bindu Kalesan
- Division of Surgery and Epidemiology, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Ulrich P Jorde
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Donna M Mancini
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York.
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21
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Haglund NA, Feurer ID, Dwyer JP, Stulak JM, DiSalvo TG, Keebler ME, Schlendorf KH, Wigger MA, Maltais S. Does renal dysfunction and method of bridging support influence heart transplant graft survival? Ann Thorac Surg 2014; 98:835-41. [PMID: 25069689 DOI: 10.1016/j.athoracsur.2014.05.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Renal insufficiency is common in status 1B patients supported with inotropes or a continuous flow left ventricular device (CF-LVAD) as a bridge to heart transplantation. We evaluated the association of renal function and inotrope versus CF-LVAD support on posttransplant graft survival in status 1B patients. METHODS The Scientific Registry for Transplant Recipients database was analyzed for posttransplant survival in status 1B patients bridged with inotropes or CF-LVAD who underwent transplantation between 2003 and 2012. Pretransplant renal function was measured by estimating glomerular filtration rate (GFR) and was stratified as less than 45 mL · min(-1) · 1.73 m(-2), 45 to 59, and 60 or greater. Univariate Kaplan-Meier and multivariate Cox regression models were used to evaluate the main effects of GFR strata and inotropes versus CF-LVAD, and the interaction effect of GFR strata by CF-LVAD, on graft survival. RESULTS This study included 4,158 status 1B patients (74% male, aged 53 ± 12 years). Of those, 659 patients had a CF-LVAD (HeartMate-II [Thoratec, Pleasanton, CA], n = 638; HVAD [HeartWare, Framingham, MA], n = 21), and 3,530 were receiving inotropes (31 CF-LVAD patients were also receiving inotropes). Kaplan-Meier analyses demonstrated reduced graft survival (p = 0.022) in patients with pretransplant GFR less than 45 versus GFR 45 to 59 (p = 0.062) and versus GFR 60 or greater (p = 0.007), and no effect of inotrope versus CF-LVAD support on graft survival (p = 0.402). Multivariate analysis demonstrated that, after adjusting for the main effects of GFR stratum, CF-LVAD, and inotropes, status 1B patients bridged with a CF-LVAD and GFR in the lowest stratum had reduced graft survival (interaction effect p = 0.040). CONCLUSIONS Pretransplant renal insufficiency was associated with reduced posttransplant graft survival in status 1B patients. This risk is increased for patients bridged with a CF-LVAD (versus inotropes) who have GFR in the lowest stratum.
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Affiliation(s)
- Nicholas A Haglund
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Irene D Feurer
- Departments of Surgery and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jamie P Dwyer
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John M Stulak
- Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Thomas G DiSalvo
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary E Keebler
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelly H Schlendorf
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark A Wigger
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Simon Maltais
- Division of Cardiovascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
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