Primary Graft Dysfunction in Patients Supported With Durable Left Ventricular Assist Devices Before Heart...

Area of Science:

• Cardiology
• Transplantation Medicine
• Medical Devices

Background:

• Single-center studies suggest a link between pre-transplant durable left ventricular assist device (LVAD) support and severe primary graft dysfunction (PGD) after heart transplantation (HT).
• Understanding this association is crucial for managing HT outcomes.

Purpose of the Study:

• To leverage international data to identify trends and quantify outcomes in LVAD-supported patients undergoing HT.
• To determine clinical risk factors associated with severe PGD in high-risk LVAD-supported patients.

Main Methods:

• A comparative analysis was conducted on clinical data and outcomes, including severe PGD, between HT recipients with and without pre-transplant LVAD support.
• Univariate and multivariable logistic regression analyses were performed on LVAD-supported patients to identify predictors of severe PGD.

Main Results:

• The study included 4,125 HT recipients; 26% had pre-transplant LVAD support.
• Severe PGD occurred in 8.6% of all patients, with a higher incidence in LVAD-supported patients (12.7%) compared to non-LVAD patients (7.4%) (P < 0.001).
• One-year mortality was significantly lower for severe PGD patients bridged with LVADs (28.8%) versus those without (40.7%) (P = 0.025).
• Risk factors for severe PGD in LVAD patients included pre-HT creatinine, central venous pressure to pulmonary capillary wedge pressure (CVP/PCWP) ratio, and donor ischemic time.

Conclusions:

• Heart transplant recipients supported by durable LVADs are at increased risk of PGD.
• Despite the higher PGD risk, LVAD support is associated with reduced mortality from this complication.
• Pre-transplant creatinine and CVP/PCWP ratio serve as surrogates of venous congestion and identify high-risk LVAD-supported patients.