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Risk analysis in patients bridged to transplantation.

L R McBride1, K S Naunheim, A C Fiore

  • 1Department of Surgery, Saint Louis University School of Medicine, Missouri, USA.

The Annals of Thoracic Surgery
|June 28, 2001
PubMed
Summary

Predicting survival for patients awaiting heart transplants on ventricular assist devices (VADs) depends on factors like intubation status, cardiopulmonary bypass time, pulmonary artery pressure, and creatinine levels. Other complications were not significant predictors.

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Area of Science:

  • Cardiology
  • Transplant Surgery
  • Critical Care Medicine

Background:

  • Predicting mortality in bridge to cardiac transplant patients often focuses on ventricular assist device (VAD) status.
  • This study aimed to identify factors influencing survival to transplant in VAD patients.

Purpose of the Study:

  • To identify independent predictors of survival to cardiac transplantation in patients supported by VADs.
  • To evaluate the predictive value of pre-operative and post-operative VAD parameters on transplant survival.

Main Methods:

  • A retrospective review of 105 bridge to transplant patients was conducted.
  • Sixty-four parameters (hemodynamics, complications, organ function) were analyzed pre- and post-VAD insertion.
  • Stepwise logistic regression was used to identify independent predictors of transplantation.

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Main Results:

  • 33 patients (31%) died on VADs; 72 were transplanted.
  • Univariate analysis identified 23 significant factors out of 64.
  • Independent predictors of transplantation included pre-VAD intubation, cardiopulmonary bypass time, post-VAD mean pulmonary artery pressure, and post-VAD creatinine.

Conclusions:

  • Pre-VAD intubation, prolonged cardiopulmonary bypass time during VAD insertion, and post-VAD renal insufficiency are key predictors of survival to transplant.
  • Pre-VAD variables, excluding intubation, had limited predictive value.
  • Severe complications like CVA, bleeding, and infection during VAD support did not predict transplantation outcomes.