Impact of Ventricular Assist Device Complications on Posttransplant Survival: An Analysis of the United Network of Organ Sharing Database

Department of Surgery, University of Utah, Salt Lake City, Utah, United States
The Annals of thoracic surgery (Impact Factor: 3.65). 12/2012; 95(3). DOI: 10.1016/j.athoracsur.2012.10.080
Source: PubMed

ABSTRACT BACKGROUND: Although current left ventricular assist device (LVAD) technology has proven more durable than first-generation devices, all mechanical devices are prone to complications that can elevate patient acuity before transplantation. LVAD patients with complications intuitively carry a higher risk profile than other status 1A LVAD patients who are generally stable and use their 30 days of clinically stable status 1A time. We sought to determine if the presence or absence of complications in status 1A LVAD patients at the time of transplant influenced survival after transplant. METHODS: The United Network of Organ Sharing database was retrospectively analyzed for 15,253 patients who were listed status 1A from 1998 to 2008. Survival after transplant survival was compared between patients who were and were not listed for LVAD-related complications. Standard statistical analysis was applied. RESULTS: No survival difference was identified at 1 and 10 years after transplant in patients who had device complications compared with those without complications. Of the five complication entries (thromboembolism, infection, malfunction, malignant arrhythmia, and other), only device infection increased mortality risk compared with noncomplicated patients (39% at 1 year, 30% at 10 years, p < 0.01). CONCLUSIONS: Long-term outcomes are generally not affected by the status 1A listing criteria for patients bridged to transplant with LVADs. However, the subset of patients with device infection had worse 1-year and 10-year posttransplant survival. Bridge to transplant patients, despite serious device-related complications, still have excellent transplant outcomes.

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    ABSTRACT: Introduction Patients supported with continuous-flow left ventricular assist devices (CF-LVADs) can develop device-related complications (DRC). We studied the HTx outcomes of status 1A patients supported with CF-LVADs with (DRC+) or without (DRC-) device-related complications. Methods UNOS data (2006 to 2012), on patients listed under status 1A with CF-LVADs at the time of HTx were analyzed. Outcomes were compared between the DRC+ and DRC- groups. DRC+ group was further analyzed under five UNOS categories: B1 to B5. Results Of the 6799 patients who received HTx under 1A listing, 2113 (31%) were supported with CF-LVADs. From 2006 to 2012, patients supported with CF-LVADs under 1A listing increased from 11.4% to 41.5% (p = 0.0001). DRC+ group (45%) compared to DRC- group (55%) had longer wait times (330±323 days vs. 168±298 days), more patients with blood group O (57% vs. 40%), and a higher BMI (29±5.5 vs. 27±5). Majority of DRCs were in B2 category (54%). Post-HTx survival for DRC+ group was significantly reduced compared to DRC- group, both at 1 year (85.6% vs. 89.9%, p = 0.01) and at 3 years (78% vs. 82.7%, p = 0.01), primarily due to B2 category. Conclusion An Increasing number of patients receiving HTx under 1A listing are supported with CF-LVADs. DRCs are steadily increasing, with a majority of them from B2 category. Post-HTx survival in DRC+ group is inferior, primarily for B2 category. The benefits of CF-LVADs for patients awaiting HTx need to be weighed against the development of DRCs with subsequently inferior post-HTx survival.
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    ABSTRACT: Objective Describe dental protocol for treating in the intensive care unit, end-stage heart-failure patients having ventricular assist devices (VAD) emergently implanted as a “bridge to heart transplantation”. This protocol permitted the rendering of safe and effective dental care in this setting and did not result in near-term (1-30 days) excessive hemorrhage, local and systemic infection, or contamination of the VAD. Study Design Descriptive cross-sectional study by UCLA Hospital Dental Service delineating dental care of 9 patients (mean age 50±12.9 years) with Class IV Stage D heart-failure. Results Nine patients, 22 days (mean) after VAD placement, received dental treatment after intravenous prophylactic antibiotics and maintenance of prior anticoagulation, antiplatelet or antithrombin regimen. Eight patients had extractions (4 mean: range 1-12) and one of them also required scaling and root planing (SRP) of the remaining teeth. A ninth individual only required SRP of four quadrants. No adverse outcomes developed. Conclusions Emergent removal of active dental disease in patients with VAD awaiting heart transplantation can be safely accomplished using established protocols with extended vigilance.
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    ABSTRACT: Heart failure remains a significant cause of morbidity and mortality, affecting over five million patients in the United States. Continuous-flow left ventricular assist devices (LVAD) have become the standard of care for patients with end stage heart failure. This review highlights the current state of LVAD as a bridge to transplant (BTT) in patients requiring mechanical circulatory support (MCS).