title: Gender differences in continuous-flow left ventricular assist device therapy as a bridge to transplantation: a risk-adjusted comparison using a propensity score-matching analysis.
abstract: The purpose of this study was to evaluate gender differences regarding outcome after continuous-flow left ventricular assist device (cfLVAD) implantation. The study was a retrospective review of prospectively collected data. Included were 24 consecutive female cfLVAD recipients and 24 male recipients (62.5% HeartMate II, 37.5% HeartWare) who received their devices between July 2007 and May 2013. Subjects were matched using propensity score analysis based on age, diagnosis, body surface area, preoperative mechanical circulatory support, heart failure severity score (INTERMACS class), and comorbidities. Female patients were significantly sicker before operation. After propensity score matching, there were no statistically significant differences in demographics or clinical baseline characteristics between male and female LVAD recipients. Also, there was a trend towards a longer postoperative intensive care unit stay in the female group (median 9 days [interquartile range 5-17] versus 15 days [interquartile range 8-33]; P < 0.061) and higher postoperative bilirubin values (median 14 mmol/L [interquartile range 10-17] versus 21 mmol/L [interquartile range 13-30]). However, there were no significant differences between the two groups in terms of outcome (P < 0.569). The overall survival was comparable between the two groups (log rank P < 0.389). Half (50%) of female patients required inotropic support for more than 7 days compared with 21.7% in the male group (P < 0.048). Half (50%) of female recipients required short-term postoperative right ventricular assist device implantation compared with 16.7% in the male group (P < 0.014). In conclusion, cfLVAD implantation as a bridge to transplantation is associated with longer duration of inotropic support and higher requirement for postoperative mechanical right ventricular support in women with similar survival rates. Further studies are required to identify additional demographic and clinical factors that modulate outcomes and will enhance the ability to risk-stratify cfLVAD recipients.
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, UK; Department of Cardiac Surgery, Heart Center, University of Heidelberg, Heidelberg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Weymann
authors.forename: Nikhil Prakash
authors.initials: NP
authors.lastname: Patil
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
authors.forename: Prashant N
authors.initials: PN
authors.lastname: Mohite
authors.forename: Diana
authors.initials: D
authors.lastname: García Sáez
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
authors.forename: Toufan
authors.initials: T
authors.lastname: Bahrami
authors.forename: Fabio
authors.initials: F
authors.lastname: De Robertis
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Banner
authors.forename: Aron-Frederik
authors.initials: AF
authors.lastname: Popov
authors.forename: André R
authors.initials: AR
authors.lastname: Simon
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D057216:Propensity Score; D012189:Retrospective Studies; D020379:Risk Adjustment / Q000379:methods*; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: Bridge to recovery; Bridge to transplantation; Continuous-flow left ventricular assist device; Gender differences