The impact of bridge-to-transplant ventricular assist device support on survival after cardiac transplantation.
OBJECTIVE
To determine the impact of bridge-to-transplant ventricular assist device support on survival after cardiac transplantation.


METHODS
From January 1, 1993, to April 30, 2009, a total of 525 cardiac transplants were performed. Ventricular assist devices were placed as a bridge to transplant in 110 patients. We focused our analysis on the 2 most common causes of end-stage heart failure requiring transplantation: idiopathic dilated cardiomyopathy (n = 201) and coronary artery disease (n = 213). Data including gender, age, date of transplant, cause of heart failure, prior heart transplant, placement of a ventricular assist device, type of ventricular assist device, and panel-reactive antibody sensitization were analyzed to derive Kaplan-Meier survival probabilities and multivariable Cox regression models.


RESULTS
In patients with idiopathic dilated cardiomyopathy who received a ventricular assist device as a bridge to transplant, survival was decreased at 1 year (P = .008) and 5 years (P = .019), but not at 10 years, posttransplant. In patients with coronary artery disease, the use of a ventricular assist device as a bridge to transplant did not influence survival at 1, 5, and 10 tears posttransplant. In patients with idiopathic dilated cardiomyopathy who received a Heartmate I (Thoratec Corp, Pleasanton, Calif) ventricular assist device as a bridge to a cardiac transplant, elevation in the pretransplant panel-reactive antibody correlated with a decrease in long-term survival.


CONCLUSIONS
In patients with idiopathic dilated cardiomyopathy, placement of a Heartmate I ventricular assist device as a bridge to a cardiac transplant is associated with an elevation in the pretransplant panel-reactive antibody and a decrease in 1- and 5-year survivals after cardiac transplantation.
Bull
David A
DA
Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA. david.bull@hsc.utah.edu
Reid
Bruce B
BB
Selzman
Craig H
CH
Mesley
Rebecca
R
Drakos
Stavros
S
Clayson
Steven
S
Stoddard
Greg
G
Gilbert
Edward
E
Stehlik
Josef
J
Bader
Feras
F
Kfoury
Abdallah
A
Budge
Deborah
D
Eckels
David D
DD
Fuller
Anne
A
Renlund
Dale
D
Patel
Amit N
AN
D000368:Aged; D000906:Antibodies / Q000097:blood; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000276:immunology / Q000401:mortality / Q000601:surgery; D003324:Coronary Artery Disease / Q000150:complications* / Q000276:immunology / Q000401:mortality / Q000601:surgery; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D014589:Utah
D000906:Antibodies