One hundred days or more bridged on a ventricular assist device and effects on outcomes following heart transplantation.
BACKGROUND
Successful bridging to transplantation (BTT) with ventricular assist devices (VAD) is an alternative to mitigate the effects of end-stage heart failure on organ function while awaiting a heart. The effects of long-term VAD BTT on patient outcomes following transplantation are poorly studied.


METHODS
A retrospective chart review identified 145 patients BTT with a VAD between November of 1996 and June of 2005 at the Cleveland Clinic. Patients were divided into two groups and outcomes were compared: group 1 was supported for <100 days (median=44 days) and group 2 was supported for > or =100 days (median=161 days).


RESULTS
Patients in group 1 were less likely to be blood type O (33% vs 68%, p<0.0001). BTT <100 days trended towards independently predicting improved survival by multivariate proportional hazards analysis (risk ratio=0.75, 95% CI=0.52-1.08, p=0.12), largely due to reduced in-hospital mortality in this group (2% vs 11%, p=0.055); however, no significant difference with respect to long-term survival was observed by Kaplan-Meier analysis (p=0.14). Furthermore, causes of death differed between groups: group 1 more commonly died of coronary artery vasculopathy (26% vs 0%, p=0.022) and group 2 more commonly died of sepsis (60% vs 26%, p=0.026). Ultimately, 21% of all group 2 patients died from sepsis (compared to 7% of group 1 patients, p=0.018).


CONCLUSIONS
This study suggests that prolonged BTT with a VAD is a viable treatment strategy but may lead to significantly more post-transplant deaths from sepsis and higher in-hospital mortality. These data may inform management of this high-risk patient population.
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Jason O
JO
Robertson
Cheryl
C
Lober
Nicholas G
NG
Smedira
Jose L
JL
Navia
Nikolai
N
Sopko
Gonzalo V
GV
Gonzalez-Stawinski
D000293:Adolescent; D000328:Adult; D000368:Aged; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology
D007166:Immunosuppressive Agents