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J Thorac Cardiovasc Surg 2008;136:774-777
© 2008 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Left ventricular assist device as bridge to transplantation does not adversely affect one-year heart transplantation survival

^a Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado at Denver and Health Sciences Center, Denver, Colorado
^b Department of Medicine, Division of Cardiology, University of Colorado at Denver and Health Sciences Center, Denver, Colorado

Received for publication July 2, 2007; revisions received November 5, 2007; accepted for publication February 12, 2008.

^_* Address for reprints: Joseph C. Cleveland Jr., MD, Associate Professor of Surgery, Surgical Director Cardiac Transplantation and MCS, Division of Cardiothoracic Surgery, University of Colorado at Denver and Health Sciences Center, Academic Office 1, L15, 12631 E. 17th Ave, C310, PO Box 6511, Aurora, CO 80045. (Email: joseph.cleveland{at}uchsc.edu).

Objective: Left ventricular assist devices are increasingly used as a bridge to transplantation. It remains unclear whether the use of pretransplant left ventricular assist devices adversely affects short-term survival after cardiac transplantation.

Methods: A retrospective review of 317 consecutive patients undergoing cardiac transplantation at an academic center between 1986 and 2006 was undertaken. Left ventricular assist devices were used pretransplant in 23 of these 317 patients, and 294 patients did not require left ventricular assist device support. Patients with a left ventricular assist device were supported with a Heartmate VE or Heartmate XVE (Thoratec Corp, Pleasanton, Calif). Kaplan–Meier survival estimates were compared between the left ventricular assist device group and the non-left ventricular assist device group using the log-rank test. In addition, occurrence of death was analyzed between the 2 groups with a chi-square analysis. The results are expressed as 1-year survival with 95% confidence intervals in parentheses.

Results: The 1-year survival for all 317 patients was 0.86 (0.82–0.90). The patient survival for the group without a left ventricular assist device before cardiac transplant was 0.87 (0.83–0.90), and the survival for the group with a left ventricular assist device as bridge to transplantation was 0.83 (0.67–0.98; P = .77). For the deaths that occurred in all 317 patients, 19% of the patients without left ventricular assist devices died within 30 days of transplant, whereas 80% of the patients with left ventricular assist devices died within 30 days of transplant (P < .01).

Conclusion: When used as a bridge to transplantation, left ventricular assist devices do not compromise 1-year survival after cardiac transplantation. Of the patients who die after transplantation, patients bridged with left ventricular assist devices are at higher risk for death within 30 days of transplant. These data suggest that left ventricular assist devices as a bridge to transplantation should be considered for appropriately selected patients awaiting cardiac transplantation.

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