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J Thorac Cardiovasc Surg 2004;127:1789-1799
© 2004 The American Association for Thoracic Surgery

Cardiothoracic transplantation

Optimal timing of cardiac transplantation after ventricular assist device implantation

^a Division of Cardiac Surgery, The University of Maryland Medical Center, Baltimore, Md, USA
^b United Network for Organ Sharing, Richmond, Va, USA
^c Division of Cardiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass, USA

Received for publication April 30, 2003; revisions received November 12, 2003; accepted for publication December 30, 2003.

^* Address for reprints: James S. Gammie, MD, Division of Cardiac Surgery, The University of Maryland Medical Center, 22 S Greene Street, N4W94, Baltimore, MD 21201, USA
jgammie{at}smail.umaryland.edu

OBJECTIVE: We sought to determine the influence of the interval from ventricular assist device implantation to cardiac transplantation on end-organ function and posttransplantation survival.

METHODS: United Network for Organ Sharing data on 2692 heart transplantations performed in adult patients in the United States between October 1999 and March 2001 were reviewed.

RESULTS: Seventeen percent (466) of adult heart transplant recipients were bridged to transplantation with a ventricular assist device. Almost half of patients with ventricular assist devices undergoing transplantation were upgraded to status 1A as a result of ventricular assist device–related complications occurring more than 30 days after ventricular assist device implantation. Creatinine and total bilirubin levels were less in patients undergoing transplantation after 2 to 4 weeks of mechanical support. One-year survival was higher in the nonventricular assist device than in the ventricular assist device group (85.7% vs 79.7%, P = .0004). Within the ventricular assist device group, survival was lower for patients undergoing transplantation within 2 weeks of ventricular assist device implantation compared with those undergoing transplantation later (74.2% vs 84.2 %, P = .03). One-year survival among patients supported with a ventricular assist device for more than 30 days without complications was 91.4%. Multivariate analysis demonstrated a significant independent effect of the time interval from ventricular assist device implantation to transplantation on posttransplantation mortality and suggested that a period of lowest risk might exist between 1 and 3 months after implantation.

CONCLUSIONS: Survival after cardiac transplantation is influenced by the time interval from ventricular assist device insertion to transplantation. Survival is significantly lower when performed within 2 to 4 weeks of ventricular assist device implantation.

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