title: Long-term outcome of high-urgency heart transplant patients with and without temporary ventricular assist device support.
abstract: BACKGROUND
  The use of short-term ventricular assist devices (VAD) in patients awaiting high-urgency (HU) heart transplantation (HTx) in Spain has steadily increased due to longer waiting times and the new heart allocation system. It is unknown whether the use of short-term VAD support in patients with cardiogenic shock affects HTx outcome. We sought to investigate long-term outcomes of HU transplanted patients with VAD compared with HU transplanted patients without device support.
  
  
  METHODS
  We retrospectively evaluated all HTx patients transplanted between 1999 and 2011 in our institution. Patients were categorized by urgency: elective HTx, HU-HTx with VAD (status 0), and HU-HTx without VAD (status 1). Actuarial survival rates were compared.
  
  
  RESULTS
  Of 237 transplanted patients, 55 (23%) were HU-HTx, including 16 on VAD support and 39 without VAD. Mean time in the HU waiting list was 6.5 ± 6 days and mean VAD support was 8.4 ± 8 days (range, 1 to 31 days). Assist devices used were Levitronix Centrimag (6), Abiomed (9), and extracorporeal membrane oxygenation (ECMO) (1). After a mean follow-up of 4.6 ± 4.1 years (range 0 to 13 years), 22 patients had died: 5 VAD and 17 non-VAD. The 1- and 5-year survival rates were 73% and 61% for the VAD and 74% and 62% for the non-VAD group, respectively (P = ns). Kaplan-Meier and Cox regression analyses did not show survival differences, HR 1.11 (95% CI 0.41-3.02), P = 0.84. The presence of renal failure was associated with increased mortality risk, HR 1.9 (95% CI 1.1-3.2), P = 0.02. The presence of renal failure was associated with increased mortality risk [HR 1.9 (95% CI 1.1-3.2), P = .02.).
  
  
  CONCLUSIONS
  In our experience, the long-term outcome of patients receiving HU-HTx under short-term VAD support is comparable to that of patients undergoing HU-HTx without VAD support. Patients with renal failure had an increased risk for overall mortality in this set of patients.
authors.affiliation: Cardiology Department, Thorax Clínic Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. macastel@clinic.ub.es
authors.forename: M A
authors.initials: MA
authors.lastname: Castel
authors.forename: R
authors.initials: R
authors.lastname: Cartañá
authors.forename: M
authors.initials: M
authors.lastname: Cardona
authors.forename: D
authors.initials: D
authors.lastname: Pereda
authors.forename: M
authors.initials: M
authors.lastname: Hernández
authors.forename: E
authors.initials: E
authors.lastname: Sandoval
authors.forename: M
authors.initials: M
authors.lastname: Castella
authors.forename: F
authors.initials: F
authors.lastname: Pérez-Villa
mesh_terms: D000328:Adult; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy*; 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; D012042:Registries; D051437:Renal Insufficiency / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D014850:Waiting Lists