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Risk factors for early death in patients bridged to transplant with continuous-flow left ventricular assist devices

George J Arnaoutakis1, Timothy J George, Arman Kilic

  • 1Division of Cardiac Surgery, The Bloomberg School of Public Health, The Johns Hopkins Hospital, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.

The Annals of Thoracic Surgery
|March 21, 2012
PubMed

Insights

Patients bridged to heart transplant (BTT) with HeartMate II mechanical assistance face risks including age and HLA mismatch. Early survival improved at high-volume centers, aiding patient selection for this advanced therapy.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Mechanical Circulatory Support

Background:

  • Bridging to heart transplant (BTT) shows comparable outcomes to conventional orthotopic heart transplantation (OHT).
  • Limited data exists on risk factors for early mortality in BTT patients using mechanical assist devices.

Purpose of the Study:

  • To identify risk factors for early death in patients bridged to OHT with a HeartMate II.
  • To improve patient selection for HeartMate II as a bridge to transplantation.

Main Methods:

  • Retrospective review of the United Network for Organ Sharing database (2005-2010).
  • Analysis of 1,312 patients bridged to OHT with HeartMate II.
  • Multivariable Cox proportional hazards regression to identify predictors of 90-day mortality.

Main Results:

  • 13.0% of patients (171/1312) died within 90 days; unadjusted 90-day survival was 92.3%.
  • Risk factors for 90-day death included older age, lower glomerular filtration rate, African American race, HLA mismatch, elevated bilirubin, mechanical ventilation, donor age, and prolonged ischemia time.
  • Patients receiving OHT at high-volume centers demonstrated improved early survival (p=0.01).

Conclusions:

  • Identified key preoperative and intraoperative risk factors for early mortality in HeartMate II BTT recipients.
  • Findings will assist clinicians in selecting appropriate candidates for mechanical circulatory support as a bridge to heart transplantation.
  • High-volume center experience is associated with better early outcomes for BTT patients.
Abstract

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