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Published on: July 18, 2014
Clinical Outcomes of Cardiac Transplantation in Heart Failure Patients with Previous Mechanical Cardiocirculatory
Michele D'Alonzo1, Amedeo Terzi2, Massimo Baudo3
1Cardiac Surgery Unit, Spedali Civili, University of Brescia, 25124 Brescia, Italy.
Insights
Left ventricular assist devices (LVADs) as a bridge to transplant (BTT) show comparable long-term survival and outcomes to direct-to-transplant (DTT) in heart failure patients. While LVADs may increase cerebrovascular events, they are a viable option for heart transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Heart failure (HF) is a major public health concern, with heart transplantation (HT) as the primary treatment for end-stage disease.
- Mechanical circulatory support, specifically left ventricular assist devices (LVADs) used as a bridge to transplant (BTT), is increasingly utilized for complex HF cases.
Purpose of the Study:
- To compare long-term clinical outcomes, including survival and post-transplant complications, between patients receiving LVADs as BTT and those undergoing direct-to-transplant (DTT) without mechanical support.
- To evaluate the impact of LVAD support on survival rates and the incidence of major complications following heart transplantation.
Main Methods:
- A retrospective, single-center study involving 105 patients who underwent HT since 2010.
- Patients were categorized into two groups: BTT (n=28) and DTT (n=77).
- Primary endpoints were 1- and 7-year post-HT survival; secondary endpoints included organ rejection, renal failure, cardiac allograft vasculopathy (CAV), and cerebrovascular events.
Main Results:
- LVAD use in the BTT group resulted in longer cardiopulmonary bypass and cross-clamping times but did not affect 30-day mortality.
- One-year survival was 89.3% for BTT vs. 85.7% for DTT, and 7-year survival was 80.8% for BTT vs. 77.1% for DTT (p > 0.05).
- No significant differences in permanent dialysis, organ rejection, or CAV were observed. However, cerebrovascular events were more frequent in the BTT group (10.7% vs. 2.6%).
Conclusions:
- LVAD support as a bridge to transplant does not adversely affect early post-transplant survival compared to direct-to-transplant.
- Long-term clinical outcomes are comparable between BTT and DTT groups, supporting LVADs as a feasible option for bridging patients to heart transplantation.
Abstract:
Objectives: Heart failure (HF) remains a significant public health issue, with heart transplantation (HT) being the gold standard treatment for end-stage HF. The increasing use of mechanical circulatory support, particularly left ventricular assist devices (LVADs), as a bridge to transplant (BTT), presents new perspectives for increasingly complex clinical scenarios. This study aimed to compare long-term clinical outcomes in patients in heart failure with reduced ejection fraction (HFrEF) receiving an LVAD as BTT to those undergoing direct-to-transplant (DTT) without mechanical support, focusing on survival and post-transplant complications. Methods: A retrospective, single-center study included 105 patients who underwent HT from 2010. Patients were divided into two groups: BTT (n = 28) and DTT (n = 77). Primary endpoints included overall survival at 1 and 7 years post-HT. Secondary outcomes involved late complications, including organ rejection, renal failure, cardiac allograft vasculopathy (CAV), and cerebrovascular events. Results: At HT, the use of LVADs results in longer cardiopulmonary bypass and cross-clamping times in the BTT group; nevertheless, surgical complexity does not affect 30-day mortality. Survival at 1 year was 89.3% for BTT and 85.7% for DTT (p = 0.745), while at 7 years, it was 80.8% and 77.1%, respectively (p = 0.840). No significant differences were observed in the incidence of major complications, including permanent dialysis, organ rejection, and CAV. However, a higher incidence of cerebrovascular events was noted in the BTT group (10.7% vs. 2.6%). Conclusions: LVAD use as BTT does not negatively impact early post-transplant survival compared to DTT. At long-term follow-up, clinical outcomes remained similar across groups, supporting LVADs as a viable option for bridging patients to transplant.
