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Duration of left ventricular assist device support affects transplant survival
R C Ashton1, D J Goldstein, E A Rose
1Department of Surgery, Allegheny General Hospital, Pittsburgh, Pa., USA.
Insights
Left ventricular assist device support exceeding 30 days before heart transplantation significantly improves patient survival. Longer support allows for end-organ normalization and better physical conditioning, reducing perioperative mortality.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Left ventricular assist devices (LVADs) are crucial for managing heart failure, serving as a bridge to transplantation.
- The optimal duration of LVAD support prior to heart transplantation remains a subject of clinical debate.
Purpose of the Study:
- To investigate the impact of left ventricular assist device support duration on survival outcomes following heart transplantation.
Main Methods:
- Retrospective analysis of patients receiving Heartmate 1,000 IP LVAD as a bridge to transplantation between 1986 and 1994.
- Comparison of perioperative mortality and end-organ function between patients supported < 30 days and > 30 days.
Main Results:
- Patients supported < 30 days experienced a threefold increase in perioperative mortality (p=0.031).
- Elevated bilirubin levels were observed in the < 30 days group at transplantation (p<0.001).
- The > 30 days support group reported a higher incidence of infections (p=0.0345).
Conclusions:
- Extended LVAD support (> 30 days) is associated with improved post-transplant survival.
- Normalization of end-organ function and enhanced physical status contribute to better outcomes with longer support durations.
- A minimum support duration of > 30 days, coupled with physical rehabilitation, is recommended to optimize early survival post-heart transplantation.
Background:
Left ventricular assist devices have become an important tool in the successful treatment of heart failure as bridges to transplantation. The optimal duration of device support before heart transplantation is debated. We report the effect of left ventricular device support duration on survival after heart transplantation.
Methods:
All patients bridged to heart transplantation with the ThermoCardiosystems Heartmate 1,000 IP left ventricular assist device between January 1, 1986, and October 15, 1994, were included in our study. Parameters studied included duration of support, measures of end-organ function, and complications while supported with the device. Patients supported < 30 days were compared with patients supported > 30 days before undergoing transplantation.
Results:
Patients supported for < 30 days had a threefold increased perioperative mortality compared with patients supported > 30 days (p = 0.031). Laboratory values of end-organ function were similar before left ventricular device insertion in both groups, although at the time of transplantation patients supported < 30 days had a significantly elevated bilirubin level compared with patients supported > 30 days (p < 0.001). Patients supported > 30 days had significantly more infections than the < 30 days group (p = 0.0345).
Conclusions:
Patients supported for > 30 days with left ventricular assist devices have improved post-transplant perioperative survival because of normalization of end-organ function and improved physiologic status secondary to aggressive physical rehabilitation. Patients should be supported for > 30 days in combination with physical rehabilitation, to improve early survival after heart transplantation.