title: Changing outcomes in patients bridged to heart transplantation with continuous- versus pulsatile-flow ventricular assist devices: an analysis of the registry of the International Society for Heart and Lung Transplantation.
abstract: BACKGROUND
  Patients bridged to heart transplantation with left ventricular assist devices (LVADs) have been reported to have higher post-transplant mortality compared with those without LVADs. Our aim was to determine the impact of the type of LVAD and implant era on post-transplant survival.
  
  
  METHODS
  In this study we included 8,557 patients from the registry of the International Society for Heart and Lung Transplantation. We examined post-transplant outcomes in 1,100 patients bridged to transplant with pulsatile-flow LVADs between January 2000 and June 2004 (first era), 880 patients bridged with pulsatile-flow LVADs between July 2004 and May 2008 (second era), and 417 patients bridged with continuous-flow LVADs in the second era. Patients who required intravenous inotropes but not LVAD support (n = 2,728) and patients who did not require either LVAD or inotropes (n = 3,432) served as controls.
  
  
  RESULTS
  Post-transplant survival of patients bridged with pulsatile LVADs improved significantly between the first and the second era (p = 0.03). In the second era, there was no significant difference in post-transplant survival of patients bridged with pulsatile- vs continuous-flow LVADs (p = 0.26), and survival rates in the 2 groups were not statistically different from that of the non-LVAD group. Graft rejection was similar in patients bridged with LVADs compared to those without LVADs.
  
  
  CONCLUSIONS
  In the most recent era, the use of either pulsatile- or continuous-flow LVADs did not result in increased post-transplant mortality. This finding is important as the proportion of patients with LVADs at the time of transplant has been rising.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City, Utah 84132, USA.
authors.forename: Jose N
authors.initials: JN
authors.lastname: Nativi
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Drakos
authors.forename: Anna Y
authors.initials: AY
authors.lastname: Kucheryavaya
authors.forename: Leah B
authors.initials: LB
authors.lastname: Edwards
authors.forename: Craig H
authors.initials: CH
authors.lastname: Selzman
authors.forename: David O
authors.initials: DO
authors.lastname: Taylor
authors.forename: Marshall I
authors.initials: MI
authors.lastname: Hertz
authors.forename: Abdallah G
authors.initials: AG
authors.lastname: Kfoury
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000145:classification* / Q000639:trends; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011673:Pulsatile Flow; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome