Post–cardiac transplant survival after support with a continuous-flow left ventricular assist device: Impact of duration of left ventricular assist device support and other variables

John, Ranjit; Pagani, Francis D.; Naka, Yoshifumi; Boyle, Andrew; Conte, John V.; Russell, Stuart D.; Klodell, Charles T.; Milano, Carmelo A.; Rogers, Joseph; Farrar, David J.; Frazier, O. Howard

doi:10.1016/j.jtcvs.2010.03.037

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 1 , Pages 174-181, July 2010

Post–cardiac transplant survival after support with a continuous-flow left ventricular assist device: Impact of duration of left ventricular assist device support and other variables

Read at the Eighty-ninth Annual Meeting of The American Association for Thoracic Surgery, Boston, Massachusetts, May 9–13, 2009.

Ranjit John, MD
- Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minn
- Address for reprints: Ranjit John, MD, Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN 55455.
Francis D. Pagani, MD
- University of Michigan, Ann Arbor, Mich
Yoshifumi Naka, MD
- Columbia University, New York, NY
Andrew Boyle, MD
- Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minn
John V. Conte, MD
- Johns Hopkins University, Baltimore, Md
Stuart D. Russell, MD
- Johns Hopkins University, Baltimore, Md
Charles T. Klodell, MD
- University of Florida, Gainesville, Fla
Carmelo A. Milano, MD
- Duke University, Durham, NC
Joseph Rogers, MD
- Duke University, Durham, NC
David J. Farrar, PhD
- Thoratec Corp, Pleasanton, Calif
O. Howard Frazier, MD
- Texas Heart Institute, Houston, Tex

Received 2 June 2009; received in revised form 7 January 2010; accepted 26 March 2010. published online 06 May 2010.

Objective

Although left ventricular assist devices (LVADs) are associated with excellent outcomes in patients with end-stage heart failure, there are conflicting reports on posttransplant survival in these patients. Furthermore, prior studies with pulsatile LVADs have shown that transplantation, either early (<6 weeks) or late (>6 months) after LVAD implantation, adversely affected post–cardiac transplant survival. We sought to determine factors related to posttransplant survival in patients supported with continuous-flow LVADs.

Methods

The HeartMate II LVAD (Thoratec Corporation, Pleasanton, Calif) was implanted in 468 patients as a bridge to transplant at 36 centers in a multicenter trial. Patients who underwent transplantation after support were stratified by demographics: gender, age, etiology, body mass index, duration of device support, and by adverse events during support. The median age was 54 years (range 18–73 years); 43% had ischemic etiology, and 18% were women. Survival was determined at the specific intervals of 30 days and 1 year after transplantation.

Results

Of 468 patients, 250 (53%) underwent cardiac transplant after a median duration of LVAD support of 151 days (longest: 3.2 years), 106 (23%) died, 12 (2.6%) recovered ventricular function and the device was removed, and 100 (21%) were still receiving LVAD support. The overall 30-day and 1-year posttransplant survivals were 97% and 87%. There were no significant differences in survival based on demographic factors or LVAD duration of less than 30 days, 30 to 90 days, 90 to 180 days, and more than 180 days. Patients requiring more than 2 units of packed red blood cells in 24 hours during LVAD support had a statistically significant decreased 1-year survival (82% vs 94%) when compared with patients who did not require more than 2 units of packed red blood cells in 24 hours during LVAD support (P = .03). There was a trend for slightly lower survival at 1 year in patients with percutaneous lead infections during LVAD support versus no infection (75% vs 89%; P = .07).

Conclusions

Post–cardiac transplant survival in patients supported with continuous-flow devices such as the HeartMate II LVAD is equivalent to that with conventional transplantation. Furthermore, posttransplant survival is not influenced by the duration of LVAD support. The improved durability and reduced short- and long-term morbidity associated with the HeartMate II LVAD has reduced the need for urgent cardiac transplantation, which may have adversely influenced survival in the pulsatile LVAD era. This information may have significant implications for changing the current United Network for Organ Sharing criteria regarding listing of heart transplant candidates.

CTSNet classification: 27

Abbreviations and Acronyms: BTT, bridge to transplant, FDA, Food and Drug Administration, LVAD, left ventricular assist device, PRBCs, packed red blood cells, UNOS, United Network for Organ Sharing