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Published on: August 2, 2024
Impact of pretransplant left ventricular assist device support duration on outcome after heart transplantation
Moritz Benjamin Immohr1, Hug Aubin1, Sophiko Erbel-Khurtsidze1
1Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Insights
The duration of left ventricular assist device (LVAD) support before heart transplantation does not significantly affect patient outcomes. This study found no clear evidence to recommend a specific LVAD support duration for heart transplant candidates.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Heart transplantation following left ventricular assist device (LVAD) implantation presents unique challenges.
- The impact of LVAD support duration on post-transplant outcomes remains incompletely understood.
Purpose of the Study:
- To investigate whether the duration of LVAD support influences morbidity and mortality after heart transplantation.
- To analyze the relationship between pre-transplant LVAD support duration and key postoperative outcomes.
Main Methods:
- Retrospective review of 198 patients who underwent heart transplantation after LVAD implantation between 2010 and 2021.
- Patients were stratified into four groups based on LVAD support duration (<90 days, 90 days to 1 year, 1-2 years, >2 years).
- Outcomes assessed included primary graft dysfunction, acute graft rejection, perioperative adverse events, and 1-year survival.
Main Results:
- No significant differences in recipient-donor mismatch were observed across groups.
- Numerically increased incidence of primary graft dysfunction in patients with shortest (<90 days) and longest (>1 year) LVAD support durations.
- A trend towards increased acute graft rejection in the shortest support duration group (P=0.06).
- LVAD support duration did not impact perioperative adverse events (infections, AKI, neurological events, bleeding) or 1-year survival.
Conclusions:
- The duration of pre-transplant LVAD support did not demonstrate a significant impact on postoperative outcomes in heart transplant recipients.
- Current data do not support recommending a specific LVAD support duration for optimizing heart transplant outcomes.
Objectives:
Heart transplantation after left ventricular assist device (LVAD) implantation remains challenging. It is still unclear whether its support duration impacts the outcome after transplantation.
Methods:
All patients undergoing heart transplantation between 2010 and 2021 at a single department after previous left ventricular assistance were retrospectively reviewed and divided into 4 different study groups with regard to the duration of LVAD support to examine the impact on the postoperative morbidity and mortality.
Results:
A total of n = 198 patients were included and assigned to the 4 study groups (group 1: <90 days, n = 14; group 2: 90 days to 1 year, n = 31; group 3: 1-2 years, n = 29; group 4: >2 years, n = 24). Although there were no differences between the 4 groups concerning relevant mismatch between the recipients and donors, the incidence of primary graft dysfunction was numerically increased in patients with the shortest support duration, and also those patients with >1 year of support (group 1: 35.7%, group 2: 25.8%, group 3: 41.4%, group 4: 37.5%, P = 0.63). The incidence of acute graft rejection was by trend increased in patients of group 1 (group 1: 28.6%, group 2: 3.3%, group 3: 7.1%, group 4: 12.5%, P = 0.06). Duration of LVAD support did not impact on perioperative adverse events (infections, P = 0.79; acute kidney injury, P = 0.85; neurological events, P = 0.74; thoracic bleeding, P = 0.61), neither on postoperative survival (1-year survival: group 1: 78.6%, group 2: 66.7%, group 3: 80.0%, group 4: 72.7%, P = 0.74).
Conclusion:
We cannot identify a significant impact of the duration of pretransplant LVAD support on postoperative outcome; therefore, we cannot recommend a certain timeframe for transplantation of LVAD patients.
