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Published on: July 18, 2014
Effects of implanting a long-term left ventricle assist device on post-transplant outcomes
Helena Bedanova1, Michal Pazdernik2, Milan Sonka3
1Center of Cardiovascular and Transplant Surgery Brno, Brno, Czech Republic.
Insights
Patients receiving a left ventricle assist device (LVAD) before heart transplantation experienced more complications. However, LVAD use did not significantly impact cardiac allograft vasculopathy or long-term survival rates.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Increasing use of left ventricle assist devices (LVADs) as a bridge to heart transplantation.
- Need to compare outcomes between LVAD and non-LVAD heart transplant recipients.
Purpose of the Study:
- To determine differences in outcomes for heart transplant patients with and without prior LVAD implantation.
- To compare survival rates and cardiac allograft vasculopathy progression.
Main Methods:
- Retrospective analysis of 248 heart transplant patients (2010-2018).
- Evaluation of donor and patient demographics, post-transplant data, and survival.
- Prospective assessment of cardiac allograft vasculopathy using optical coherence tomography at 1 and 12 months.
Main Results:
- 48 patients received LVADs pre-transplant; 200 did not. No donor characteristic differences.
- LVAD group had longer cardiopulmonary bypass (175 vs 156 min), increased blood loss (1045 vs 650 mL), and higher ECMO need (23% vs 10%).
- No significant difference in 1-year cardiac allograft vasculopathy progression (p=0.528) or 1- and 5-year survival (p=0.945).
Conclusions:
- LVAD patients face more intraoperative and post-operative complications during heart transplantation.
- LVAD use shows no significant impact on cardiac allograft vasculopathy progression.
- Long-term survival rates are comparable between LVAD and non-LVAD heart transplant recipients.
Background:
An increasing number of patients are receiving left ventricle assist devices as a bridge to heart transplantation. The aim of this study was to determine the difference between patients who received transplants from a left ventricle assist device and those who underwent heart transplantation without a prior left ventricle assist device implantation.
Material And Methods:
The study included patients who underwent heart transplantation in our institute between January 2010 and November 2018. The following clinical variables were evaluated: donor characteristics, patient's pre-transplant demographical data, post-transplant data, and patient survival. Cardiac allograft vasculopathy progression was prospectively examined (after 1 month and 12 months after heart transplantation) by coronary optical coherence tomography. We were interested in the difference in 1- and 5-year survival between the left ventricle assist device and non-left ventricle assist device groups.
Results:
A total of 248 patients were identified; out of them, 48 patients received a left ventricle assist device before heart transplantation, whereas 200 had transplants with no prior left ventricle assist device implantation. There were no significant differences in any donor characteristics. The mean duration of cardiopulmonary bypass time in the non-left ventricle assist device group was 156 versus 175 min in the left ventricle assist device group (p = 0.009), blood loss was 650 versus 1045 mL (p < 0.001), the need to implant an extracorporeal membrane oxygenation was 10% versus 23% (p = 0.02). There was no difference in cardiac allograft vasculopathy progression between the groups 1 year after heart transplantation (p = 0.528). The 1- and 5-year survival, according to Kaplan-Meier, was 80% and 70% in the left ventricle assist device group, compared to 80% and 73%, respectively, in the non-left ventricle assist device group (Log-rank test: p = 0.945).
Conclusion:
Our results indicate that patients undergoing heart transplantation from left ventricle assist devices suffer significantly more from intraoperative and post-operative complications; however, only insignificant cardiac allograft vasculopathy progression and survival differences between the two groups were observed.
