title: The impact of pretransplantation urgency status and the presence of a ventricular assist device on outcome after heart transplantation.
abstract: BACKGROUND
  There are conflicting reports on the posttransplantation morbidity and mortality of patients listed urgently and/or supported by a ventricular assist device (VAD). The aim of this study was to analyze the outcomes with regard to pretransplantation condition (elective, urgent, VAD).
  
  
  METHODS
  All adult recipients between January 1, 2005, and October 31, 2012, were included. Demographics; preoperative, operative, and postoperative data; outpatient follow-up; and donor characteristics were collected and analyzed.
  
  
  RESULTS
  Of a total of 74 patients, 19 were listed urgently, 20 had a Berlin Heart EXCOR BVAD (biventricular assist device) (Berlin Heart, Berlin, Germany) (8 urgent), 7 had a Berlin Heart INCOR left VAD (Berlin Heart, Berlin, Germany) (2 urgent), and 2 had a HeartWare left VAD (HeartWare International, Framingham, Mass, USA) (none urgent). Mean age was 52 ± 12years. The overall 30-day, 1-year, and 3-year survival was 90% ± 3%, 79% ± 5%, and 66% ± 7%. There was no difference in survival when comparing urgently listed (95% ± 5%, 84% ± 8%, 74% ± 12%) and elective patients (89% ± 4%, 77% ± 6%, 63% ± 8%; P = .4), and VAD patients (86% ± 6%, 76% ± 8%, 63% ± 11%) and those without mechanical support (93% ± 4%, 81% ± 6%, 69% ± 9%; P = .6). In-hospital outcomes and long-term complications were also comparable.
  
  
  CONCLUSIONS
  Our series suggests that urgent patients and patients on a VAD have a posttransplantation outcome comparable to elective patients and patients without a VAD. These data support the effectiveness of the current practice of listing for heart transplantation.
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland. Electronic address: diana.reser@usz.ch.
authors.forename: D
authors.initials: D
authors.lastname: Reser
authors.affiliation: Cardiovascular Center Cardiology, University Hospital, Zurich, Switzerland.
authors.forename: G M
authors.initials: GM
authors.lastname: Fröhlich
authors.affiliation: Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
authors.forename: M L
authors.initials: ML
authors.lastname: Lachat
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Jacobs
authors.affiliation: Cardiovascular Center Cardiology, University Hospital, Zurich, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Enseleit
authors.affiliation: Cardiovascular Center Cardiology, University Hospital, Zurich, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Ruschitzka
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
authors.forename: V
authors.initials: V
authors.lastname: Falk
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
authors.forename: M J
authors.initials: MJ
authors.lastname: Wilhelm
mesh_terms: D000368:Aged; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome