title: Late right heart failure during support with continuous-flow left ventricular assist devices adversely affects post-transplant outcome.
abstract: BACKGROUND
  Right heart failure (RHF) is an unresolved issue during continuous-flow left ventricular assist device (LVAD) support. Little is known about post-transplant outcomes in patients complicated by late RHF during LVAD support.
  
  
  METHODS
  Between May 2004 and December 2013, 141 patients underwent cardiac transplantation after isolated LVAD bridging at our center. Late RHF was defined as heart failure requiring medical intervention >4 weeks after LVAD implantation.
  
  
  RESULTS
  The patients' mean age was 53 ± 13 years, 82% were men, and 36% had an ischemic etiology. The mean duration of LVAD support before transplantation was 0.75 years. Late RHF developed in 21 patients (15%) during LVAD support. Of these patients, 11 were supported with inotropic agents at the time of transplantation. Patients with RHF had higher creatinine (1.6 ± 0.88 mg/dL vs 1.3 ± 0.67 mg/dL, p = 0.07), higher blood urea nitrogen (32 ± 17 mg/dL vs 24 ± 10 mg/dL, p = 0.0013), higher total bilirubin (0.96 ± 0.46 mg/dL vs 0.78 ± 0.42 mg/dL, p = 0.07), and lower albumin (3.8 ± 0.60 g/dL vs 4.1 ± 0.46 g/dL, p = 0.0019) at the time of transplantation compared with patients who did not develop RHF. In-hospital mortality was significantly higher in patients with late RHF during LVAD support (29% vs 6.7%, p = 0.002). Overall post-transplant survival rates were 87% at 1 year, 83% at 3 years, and 77% at 5 years. The 5-year post-transplant survival was significantly worse in patients who developed late RHF during LVAD support compared with survival in patients who did not develop RHF (26% vs 87%, p < 0.0001).
  
  
  CONCLUSIONS
  Late RHF during LVAD support adversely affects post-transplant survival.
authors.affiliation: Departments of (a)Surgery, Division of Cardiothoracic Surgery. Electronic address: kt2485@cumc.columbia.edu.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Departments of (a)Surgery, Division of Cardiothoracic Surgery.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.affiliation: Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
authors.affiliation: Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Melana
authors.initials: M
authors.lastname: Yuzefpolskaya
authors.affiliation: Departments of (a)Surgery, Division of Cardiothoracic Surgery.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Fukuhara
authors.affiliation: Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: Departments of (a)Surgery, Division of Cardiothoracic Surgery.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: continuous flow; right heart failure; survival; transplantation; ventricular assist device