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Mark J. Russo
Ryan R. Davies
Jonathan M. Chen
Mathew R. Williams
Annetine C. Gelijns
Allan S. Stewart
Michael Argenziano
Yoshifumi Naka
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Right arrow Transplantation - heart

J Thorac Cardiovasc Surg 2009;138:1425-1432
© 2009 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Posttransplant survival is not diminished in heart transplant recipients bridged with implantable left ventricular assist devices

Mark J. Russo, MD, MSa, Kimberly N. Hong, MHSAa,b, Ryan R. Davies, MDa, Jonathan M. Chen, MDa, Robert A. Sorabella, BAa, Deborah D. Ascheim, MDb, Mathew R. Williams, MDa, Annetine C. Gelijns, PhDb, Allan S. Stewart, MDa, Michael Argenziano, MDa, Yoshifumi Naka, MD, PhDb,*

a Division of Cardiothoracic Surgery, Columbia University, New York, NY
b Department of Health Policy, Mount Sinai Medical Center, New York, NY

Received for publication July 25, 2008; revisions received June 17, 2009; accepted for publication July 14, 2009.

* Address for reprints: Yoshifomi Naka, MD, PhD, New York–Presbyterian Hospital/Columbia, Milstein Hospital Bldg Room 7-435 GN, 177 Fort Washington Ave, New York, NY 10032. (Email: yn33{at}columbia.edu).

Background: The purpose of this study was to compare posttransplantation morbidity and mortality in orthotopic heart transplant recipients bridged to transplant with a left ventricular assist device with nonbridged recipients. To account for potential differences across device types, we stratified bridge-to-transplant recipients by type of ventricular assist device: extracorporeal (EXTRA), paracorporeal (PARA), and intracorporeal (INTRA).

Methods: The United Network for Organ Sharing provided de-identified patient-level data. The study population included 10,668 orthotopic heart transplant recipients aged 18 years old or older and undergoing transplantation between January 1, 2001, and December 31, 2006. Follow-up data were provided through August 3, 2008, with a mean follow-up time of 3.17 ± 2.15 years (range, 0–8.11 years). The primary outcome was actuarial posttransplant graft survival. Other outcomes of interest included infection, stroke, and dialysis during the transplant hospitalization; primary graft failure at 30 days; transplant hospitalization length of stay; and long-term complications including diabetes mellitus, transplant coronary artery disease, and chronic dialysis. Multivariable Cox proportional hazards regression (backward, P < .15) was used to determine the relationship between groups and overall graft survival, and multivariable logistic regression analysis (backward, P < .15) was used to determine the relationship between groups and secondary outcome measures.

Results: In multivariable Cox regression analysis, when compared with the nonbridged group, risk-adjusted greater than 90-day graft survival was diminished among the EXTRA group (hazard ratio = 3.54, 2.28–5.51, P < .001), but not the INTRA group (1.04, 0.719–1.51, P = .834) or the PARA group (1.06, 0.642–1.76, P = .809). There were no significant differences in risk-adjusted graft survival across the 4 groups during the 90-days to 1-year or 1- to 5-year intervals. However, at more than 5 years, risk-adjusted graft survival in the INTRA group (0.389, 0.205–0.738, P = .004) was better than in the nonbridged group. The EXTRA, PARA, and INTRA groups all experienced increased risks of infection. The EXTRA group had increased risks of dialysis, stroke, and primary graft failure at 30 days, whereas neither the PARA nor the INTRA group differed from the nonbridged group. Long-term complications did not differ by group.

Conclusion: The use of implantable left ventricular assist devices as bridges to transplantation, including both intracorporeal and paracorporeal devices, is not associated with diminished posttransplant survival. However, 90-day survival was diminished in recipients bridged with extracorporeal devices.

Abbreviations and Acronyms BTT = bridge to transplantation; EXTRA = extracorporeal ventricular assist device; INTRA = intracorporeal ventricular assist device; LVAD = left ventricular assist device; PARA = paracorporeal ventricular assist device; UNOS = United Network for Organ Sharing; VAD = ventricular assist device






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