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Immohr MB, Boeken U, Mueller F, Prashovikj E, Morshuis M, Böttger C, Aubin H, Gummert J, Akhyari P, Lichtenberg A, Schramm R. Complications of left ventricular assist devices causing high urgency status on waiting list: impact on outcome after heart transplantation. ESC Heart Fail 2021; 8:1253-1262. [PMID: 33480186 PMCID: PMC8006689 DOI: 10.1002/ehf2.13188] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/19/2020] [Accepted: 12/11/2020] [Indexed: 01/10/2023] Open
Abstract
Aims Heart transplantation (HTx) represents optimal care for advanced heart failure. Left ventricular assist devices (LVADs) are often needed as a bridge‐to‐transplant (BTT) therapy to support patients during the wait for a donor organ. Prolonged support increases the risk for LVAD complications that may affect the outcome after HTx. Methods and results A total of 342 patients undergoing HTx after LVAD as BTT in a 10‐year period in two German high‐volume HTx centres were retrospectively analysed. While 73 patients were transplanted without LVAD complications and with regular waiting list status (T, n = 73), the remaining 269 patients were transplanted with high urgency status (HU) and further divided with regard to the observed leading LVAD complications (infection: HU1, n = 91; thrombosis: HU2, n = 32; stroke: HU3, n = 38; right heart failure: HU4, n = 41; arrhythmia: HU5, n = 23; bleeding: HU6, n = 18; device malfunction: HU7, n = 26). Postoperative hospitalization was prolonged in patients with LVAD complications. Analyses of perioperative morbidity revealed no differences regarding primary graft dysfunction, renal failure, and neurological events except postoperative infections. Short‐term survival, as well as Kaplan–Meier survival analysis, indicated comparable results between the different study groups without disadvantages for patients with LVAD complications. Conclusions Left ventricular assist device therapy can impair the outcome after HTx. However, the occurrence of LVAD complications may not impact on outcome after HTx. Thus, we cannot support the prioritization or discrimination of HTx candidates according to distinct mechanical circulatory support‐associated complications. Future allocation strategies have to respect that device‐related complications may define urgency but do not impact on the outcome after HTx.
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Affiliation(s)
- Moritz Benjamin Immohr
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Franziska Mueller
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Georgstrasse 11, Bad Oeynhausen, 32545, Germany
| | - Emir Prashovikj
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Georgstrasse 11, Bad Oeynhausen, 32545, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Georgstrasse 11, Bad Oeynhausen, 32545, Germany
| | - Charlotte Böttger
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Georgstrasse 11, Bad Oeynhausen, 32545, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - René Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Georgstrasse 11, Bad Oeynhausen, 32545, Germany
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Sridharan L, Wayda B, Truby LK, Latif F, Restaino S, Takeda K, Takayama H, Naka Y, Colombo PC, Maurer M, Farr MA, Topkara VK. Mechanical Circulatory Support Device Utilization and Heart Transplant Waitlist Outcomes in Patients With Restrictive and Hypertrophic Cardiomyopathy. Circ Heart Fail 2019; 11:e004665. [PMID: 29664407 DOI: 10.1161/circheartfailure.117.004665] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 02/13/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with restrictive cardiomyopathy (RCM) and hypertrophic cardiomyopathy (HCM) generally are considered poor candidates for mechanical circulatory support devices (MCSDs) and often not able to be bridged mechanically to heart transplantation. This study characterized MCSD utilization and transplant waitlist outcomes in patients with RCM/HCM under the current allocation system and discusses changes in the era of the new donor allocation system. METHODS AND RESULTS Patients waitlisted from 2006 to 2016 in the United Network for Organ Sharing registry were stratified by RCM/HCM versus other diagnoses. MCSD utilization and waitlist duration were analyzed by propensity score models. Waitlist outcomes were assessed by cumulative incidence functions with competing events. Predictors of waitlist mortality or delisting for worsening status in patients with RCM/HCM were identified by proportional hazards model. Of 30 608 patients on the waitlist, 5.1% had RCM/HCM. Patients with RCM/HCM had 31 fewer waitlist days (P<0.01) and were ≈26% less likely to receive MCSD (P<0.01). Cumulative incidence of waitlist mortality was similar between cohorts; however, patients with RCM/HCM had higher incidence of heart transplantation. Predictors of waitlist mortality or delisting for worsening status in patients with RCM/HCM without MCSD support included estimated glomerular filtration rate <60 mL/min per 1.73 m2, pulmonary capillary wedge pressure >20 mm Hg, inotrope use, and subjective frailty. CONCLUSIONS Patients with RCM/HCM are less likely to receive MCSD but have similar waitlist mortality and slightly higher incidence of transplantation compared with other patients. The United Network for Organ Sharing RCM/HCM risk model can help identify patients who are at high risk for clinical deterioration and in need of expedited heart transplantation.
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Affiliation(s)
- Lakshmi Sridharan
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Brian Wayda
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Lauren K Truby
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Farhana Latif
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Susan Restaino
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Koji Takeda
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Hiroo Takayama
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Yoshifumi Naka
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Paolo C Colombo
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Mathew Maurer
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Maryjane A Farr
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Veli K Topkara
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY.
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Cantrelle C, Dorent R, Legeai C, Damy T, Bastien O, Tuppin P. Hospitalisation and life support in the year before and during heart transplantation: a French national study. Open Heart 2019; 5:e000913. [PMID: 30613415 PMCID: PMC6307614 DOI: 10.1136/openhrt-2018-000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/03/2018] [Accepted: 11/10/2018] [Indexed: 11/04/2022] Open
Abstract
Objective The objective of this study was to define the characteristics of hospital care use during the year prior to heart transplantation. Methods A retrospective cohort of heart transplant recipients registered on the national hospital discharge database between 2010 and 2015 was analysed. Results In this cohort of 2379 heart transplant recipients (mean age: 48 years, 74% men), 91% had been admitted at least once, for at least 1 day, to a short-stay hospital during the year before transplantation (mean: 4.3 days), and 84% had at least one cardiovascular diagnosis (heart failure and cardiogenic shock: 60%). At least one intensive care stay was reported for 61% of patients, a rehabilitation stay was reported for 30%, mechanical circulatory support was reported for 12%, and ventilatory support was reported for 15%. The median interval between admission and transplantation was 5 days (interquartile QI-Q3, 0-16). The hospital mortality was higher for patients not hospitalised before transplantation (18% vs 15%). Their transplantation hospitalisation diagnosis, compared with patients hospitalised before transplantation, was more frequently cardiomyopathy (31% vs 27%) or heart failure (28% vs 18%), and less frequently myocardial infarction (1% vs 12%). Conclusion This study demonstrates a high hospitalisation rate before heart transplantation and identifies three groups of patients: 1-patients with a high hospitalisation rate and terminal heart failure requiring circulatory support who experienced at least one intensive care unit stay; 2-patients with a history of hospitalisation, mainly for heart disease, without circulatory support requirement; and 3-patients with no pretransplantation overnight stay. These findings provide useful information to evaluate the medical benefits and needs for transplantation, and identify areas for improvement in heart transplantation listing criteria.
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Affiliation(s)
- Christelle Cantrelle
- Direction Prélèvement Greffe Organes Tissus (DPGOT), Agence de la biomédecine, Saint Denis, France
| | - Richard Dorent
- Direction Prélèvement Greffe Organes Tissus (DPGOT), Agence de la biomédecine, Saint Denis, France
| | - Camille Legeai
- Direction Prélèvement Greffe Organes Tissus (DPGOT), Agence de la biomédecine, Saint Denis, France
| | - Thibaud Damy
- Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Olivier Bastien
- Direction Prélèvement Greffe Organes Tissus (DPGOT), Agence de la biomédecine, Saint Denis, France
| | - Philippe Tuppin
- Département d'Etudes sur les Pathologies et les Patients (DEPP), Caisse Nationale d'Assurance Maladie, Paris, France
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