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Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart
Published on: May 11, 2018
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Racial Disparities in Patients Bridged to Heart Transplantation With Left Ventricular Assist Devices
Cecillia Lui1, Charles D Fraser1, Xun Zhou1
1Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
The Annals of Thoracic Surgery
|April 30, 2019
Summary
African Americans bridged to heart transplant with a left ventricular assist device (LVAD) experienced higher graft failure and decreased 5-year survival. This highlights a need for targeted clinical attention in this patient group.
Area of Science:
- Cardiology
- Transplantation Medicine
- Health Disparities
Background:
- Left ventricular assist devices (LVADs) are crucial for end-stage heart failure patients awaiting heart transplantation.
- Understanding racial disparities in outcomes for LVAD patients is essential for equitable care.
Purpose of the Study:
- To investigate the impact of race on the survival and graft failure rates of patients bridged to heart transplantation using LVADs.
Main Methods:
- Analysis of the United Network of Organ Sharing database (2005-2018) for adult heart transplant recipients bridged with LVADs.
- Stratification by race (Whites as reference), with assessment of demographic factors, 5-year survival, and graft failure.
- Statistical analyses included chi-squared tests, ANOVA, Kaplan-Meier, log-rank tests, and Cox/logistic regression.
Main Results:
- A cohort of 6476 patients (4263 White, 1536 African American, 508 Hispanic, 169 Asian) was analyzed.
- African Americans showed higher BMI, greater female representation, and different insurance/employment statuses compared to Whites.
- African Americans had significantly increased odds of graft failure (OR 1.27, P=.048) and a higher risk of 5-year mortality (HR 1.26, P=.003).
Conclusions:
- The African American race is linked to poorer outcomes, including higher graft failure and reduced 5-year survival post-heart transplant in LVAD-bridged patients.
- These findings suggest a need for focused clinical attention and potentially tailored management strategies for African American patients undergoing LVAD therapy.
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