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Heart transplantation outcomes in patients with continuous-flow left ventricular assist device-related complications

Mohammed A Quader1, Luke G Wolfe1, Vigneshwar Kasirajan1

  • 1Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|August 25, 2014
PubMed

Insights

Patients with device-related complications (DRC) on continuous-flow left ventricular assist devices (CF-LVADs) experience reduced heart transplant survival. Careful consideration of CF-LVAD benefits versus DRC risks is crucial for patients awaiting heart transplantation.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Medical Devices

Background:

  • Device-related complications (DRC) are a concern for patients with continuous-flow left ventricular assist devices (CF-LVADs).
  • This study examines heart transplant (HTx) outcomes for United Network of Organ Sharing (UNOS) Status 1A patients with CF-LVADs, comparing those with and without DRCs.

Purpose of the Study:

  • To evaluate the impact of device-related complications (DRC) on heart transplant (HTx) outcomes in UNOS Status 1A patients supported by continuous-flow left ventricular assist devices (CF-LVADs).

Main Methods:

  • Analysis of UNOS data from 2006-2012 for Status 1A patients undergoing HTx with CF-LVADs.
  • Comparison of outcomes between patients with (DRC+) and without (DRC-) device-related complications.
  • Further subgroup analysis of DRC+ patients based on UNOS categories B1-B5.

Main Results:

  • The proportion of 1A listed patients supported by CF-LVADs increased significantly from 11.4% to 41.5% between 2006 and 2012.
  • DRC+ patients (45%) had longer waiting times, higher prevalence of blood group O, and greater BMI compared to DRC- patients (55%).
  • Post-HTx survival was significantly lower at 1 and 3 years for the DRC+ group (85.6% and 78%) versus the DRC- group (89.9% and 82.7%), with most complications in the B2 category.

Conclusions:

  • An increasing number of heart transplant recipients are supported by CF-LVADs, with a rising incidence of DRCs, particularly in the B2 category.
  • Post-transplant survival is inferior in patients with DRCs, especially those in the B2 category.
  • The advantages of CF-LVADs must be balanced against the risks of DRCs and their impact on long-term heart transplant outcomes.
Abstract

Keywords:
United Network of Organ Sharingcontinuous-flowdevice-related complicationsheart transplantationleft ventricular assist device

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