The impact of bridge-to-transplant ventricular assist device support on survival after cardiac transplantation

Presented at the 32nd Annual Meeting of the Western Thoracic Surgical Association, June 24–27, 2009, Banff, Alberta, Canada.

Received 18 June 2009; received in revised form 5 March 2010; accepted 21 March 2010. published online 10 May 2010.

Objective

To determine the impact of bridge-to-transplant ventricular assist device support on survival after cardiac transplantation.

Methods

From January 1, 1993, to April 30, 2009, a total of 525 cardiac transplants were performed. Ventricular assist devices were placed as a bridge to transplant in 110 patients. We focused our analysis on the 2 most common causes of end-stage heart failure requiring transplantation: idiopathic dilated cardiomyopathy (n = 201) and coronary artery disease (n = 213). Data including gender, age, date of transplant, cause of heart failure, prior heart transplant, placement of a ventricular assist device, type of ventricular assist device, and panel-reactive antibody sensitization were analyzed to derive Kaplan–Meier survival probabilities and multivariable Cox regression models.

Results

In patients with idiopathic dilated cardiomyopathy who received a ventricular assist device as a bridge to transplant, survival was decreased at 1 year (P = .008) and 5 years (P = .019), but not at 10 years, posttransplant. In patients with coronary artery disease, the use of a ventricular assist device as a bridge to transplant did not influence survival at 1, 5, and 10 tears posttransplant. In patients with idiopathic dilated cardiomyopathy who received a Heartmate I (Thoratec Corp, Pleasanton, Calif) ventricular assist device as a bridge to a cardiac transplant, elevation in the pretransplant panel-reactive antibody correlated with a decrease in long-term survival.

Conclusion

In patients with idiopathic dilated cardiomyopathy, placement of a Heartmate I ventricular assist device as a bridge to a cardiac transplant is associated with an elevation in the pretransplant panel-reactive antibody and a decrease in 1- and 5-year survivals after cardiac transplantation.

CTSNet classification: 22, 27, 34

Abbreviations and Acronyms: CAD, coronary heart disease, CI, confidence interval, HR, hazard ratio, IDC, idiopathic dilated cardiomyopathy, LVAD, left ventricular assist device, PRA, panel-reactive antibody, UTAH, Utah Transplant Affiliated Hospitals, VAD, ventricular assist device

a Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah

b Department of Cardiology, University of Utah Health Sciences Center, Salt Lake City, Utah

c Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah

d Division of Cardiothoracic Surgery, Department of Surgery, Intermountain Medical Center, Murray, Utah

e Department of Cardiology, Intermountain Medical Center, Murray, Utah

f University of Utah Study Design and Biostatistics Center, Salt Lake City, Utah

Address for reprints: David A. Bull, MD, Professor of Surgery, Division of Cardiothoracic Surgery, University of Utah Health Sciences Center, Room 3C127, 30 North 1900 East, Salt Lake City, UT 84132.

Disclosures: None.

PII: S0022-5223(10)00321-1

doi:10.1016/j.jtcvs.2010.03.026

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