Lack of sensitization and equivalent post-transplant outcomes with the Novacor left ventricular assist device.
BACKGROUND
Ventricular assist devices (VADs) are increasingly used to support critically ill heart failure patients awaiting transplantation. Previous work has focused on the Thoratec Heartmate VE device, use of which is associated with pre-formed antibody production. We reviewed our cumulative experience with the Worldheart Novacor VAD as a bridge to transplantation (BTT).


METHODS
From January 1989 through October 2002, 39 patients required a VAD bridge, with 26 of 39 surviving to transplantation. Antibody levels were assessed by complement-dependent cytotoxicity assay at routine intervals and expressed as panel reactive antibody (PRA) levels. Post-transplant allograft rejection, coronary vasculopathy, and survival were compared between Novacor-supported patients and non-VAD transplant recipients.


RESULTS
PRA values did not significantly change after VAD implantation (12.4% +/- 11.2% vs 14.8% +/- 12.3%, p = 0.28). Survival for the BTT patients was 80.4%, 75.7%, 64.0%, 64.0%, and 64.0%, respectively, for 1, 3, 5, 7, and 10 years post-transplant, with similar results for non-BTT patients. The freedom from coronary vasculopathy was 90.2%, 90.2%, 72.2%, and 72.2%, respectively, at 1, 3, 5, and 7 years post-transplant.


CONCLUSIONS
First, to our knowledge, this study is the first to examine the incidence of allosensitization after Novacor implant in detail. In contrast with previous results of work with other VAD systems, as assessed by PRA levels, Novacor patients did not become sensitized. Second, compared with 220 non-BTT patients who received transplants during a similar time frame, Novacor BTT patients had equivalent rejection profiles and survival. Finally, the incidence of transplant-associated coronary artery disease was lower than in previous reports.
Baran
David A
DA
Newark Beth Israel Medical Center, Newark, New Jersey, USA. dbaran@SBHCS.com
Gass
Alan L
AL
Galin
Ira D
ID
Zucker
Mark J
MJ
Arroyo
Luis H
LH
Goldstein
Daniel J
DJ
Prendergast
Thomas
T
Lubitz
Steven
S
Courtney
Mary C
MC
Correa
Rhodora
R
Chan
Ming
M
Spielvogel
David
D
Lansman
Steven L
SL
D000328:Adult; D003327:Coronary Disease / Q000453:epidemiology / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006680:HLA Antigens / Q000276:immunology; D016027:Heart Transplantation / Q000009:adverse effects; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D006680:HLA Antigens