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Published on: August 2, 2024
Impact of Left-Ventricular Assist Device-Related Complications on Posttransplant Graft Survival
Dhaval Chauhan1, Alexis K Okoh2, Setri Fugar3
1Department of Cardiothoracic Surgery, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey; Department of General Surgery, Rutgers University Medical School, Newark, New Jersey.
Insights
Continuous-flow left-ventricular-assist device (CF-LVAD) complications are common in heart transplant patients. However, these device-related complications (DRCs) do not negatively impact long-term graft survival after transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Advanced heart failure often necessitates mechanical circulatory support.
- Continuous-flow left-ventricular-assist devices (CF-LVADs) are utilized as a bridge to heart transplantation.
- Understanding the impact of CF-LVAD complications on transplant outcomes is crucial.
Purpose of the Study:
- To investigate the association between CF-LVAD-related complications and postoperative graft survival.
- To identify risk factors for graft failure following heart transplantation in CF-LVAD patients.
Main Methods:
- Analysis of United Network for Organ Sharing (UNOS) data from 2005-2015.
- Inclusion of CF-LVAD patients bridged to heart transplant.
- Categorization of device-related complications (DRCs) and multivariable Cox regression analysis.
Main Results:
- Device-related infections were the most common complication (22.41%).
- Over 50% of patients had no reported DRCs prior to transplant.
- No CF-LVAD complication category independently predicted poor graft survival.
Conclusions:
- Device-related complications are frequent in CF-LVAD patients undergoing heart transplantation.
- Contrary to expectations, these complications do not adversely affect postoperative graft survival.
- Donor age, recipient's clinical status, and perioperative support influence graft outcomes.
Background:
This study describes the impact of continuous-flow left-ventricular-assist device (CF-LVAD)-related complications on postoperative outcomes.
Methods:
The United Network for Organ Sharing (UNOS) heart transplant follow-up data from 2005 to 2015 were obtained. CF-LVAD patients who were bridged to transplant were studied. Device-related complications (DRCs) at patient's last follow-up before transplantation were reported in 5 categories: device thrombosis (B1), infection (B2), device malfunction (B3), life-threatening arrhythmias (B4), and others (B5). Multivariable Cox regression models were used to evaluate the association of each category of complications and number of complications with postoperative graft survival.
Results:
Of 3,877 patients analyzed, incidence of DRCs was as following: 374 (9.65%) for thrombosis (B1), 869 (22.41%) for device-related infection (B2), 400 (10.32%) for device malfunction (B3), 135 (3.48%) for life-threatening arrhythmias (B4), and 510 (13.15%) for others (B5). A total of 2,018 (52.05%) patients did not have any DRC at last follow-up; 1,482 (38.23%) patients had 1 DRC and 377 (9.72%) patients had 2 or more DRCs. Mean time from last preoperative follow-up to transplant in patients with 0, 1, and 2 or more DRCs was 93, 18, and 11 days, respectively. Multivariate analysis showed that none of the complications (from B1 to B5) were independent risk factors for poor graft survival after cardiac transplantation. Independent predictors of postoperative graft failure were increasing donor age, inpatient status, increasing body mass index, poor functional status, ventilator dependence, and extracorporeal membrane oxygenation at the time of transplant.
Conclusions:
DRCs are common among advanced heart failure patients bridged to transplant with CF-LVADs. Contrary to popular belief, DRCs are not associated with poor postoperative graft survival.
