title: Right ventricular assist device results in worse post-transplant survival.
abstract: BACKGROUND
  To our knowledge, how the need for a right ventricular assist device (RVAD) with a left ventricular assist device (LVAD) affects outcomes after orthotopic heart transplantation has not been studied in a multi-institutional database.
  
  
  METHODS
  The United Network for Organ Sharing (UNOS) database was queried for all adult orthotopic heart transplantations from the period 2005-2012. Patients requiring a RVAD + LVAD as a bridge to transplant were compared with patients requiring a LVAD only and patients requiring no ventricular assist device (VAD).
  
  
  RESULTS
  During the study period, 16,955 orthotopic heart transplantations were performed. Of these, 13,209 (77.9%) patients did not require a VAD, 3,270 (19.3%) required a LVAD only, and 457 (2.7%) required a RVAD + LVAD. The RVAD + LVAD group had the longest length of stay (25.7 days) compared with the no VAD group (20.8 days) and the LVAD-only group (21.1 days) (p < 0.001). On multivariate analysis, requirement of a RVAD + LVAD before transplantation was independently associated with post-transplant mortality (hazard ratio 1.22, 95% confidence interval 1.01-1.49, p = 0.04). Other variables associated with mortality included donor age, pulsatile flow LVAD as a bridge to transplant, prolonged ischemic time, worsening renal function, black race, history of diabetes in recipient, class II panel-reactive antibody >10%, sex mismatch, and extracorporeal membrane oxygenation or mechanical ventilation as a bridge to transplant.
  
  
  CONCLUSIONS
  The requirement of a RVAD in addition to a LVAD before orthotopic heart transplantation is associated with worse post-transplant outcomes and increased mortality.
authors.affiliation: Department of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.affiliation: Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors.forename: Senthil N
authors.initials: SN
authors.lastname: Jayarajan
authors.affiliation: Department of Public Health, Temple University, Philadelphia, Pennsylvania.
authors.forename: Eugene
authors.initials: E
authors.lastname: Komaroff
authors.affiliation: Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut. Electronic address: Abeel.Mangi@yale.edu.
authors.forename: Abeel A
authors.initials: AA
authors.lastname: Mangi
mesh_terms: D000328:Adult; D019992:Databases as Topic; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006353:Heart-Assist Devices; D006801:Humans; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D016896:Treatment Outcome
keywords: congestive heart failure; heart failure; heart transplantation; left ventricular assist device; mechanical circulatory support; right ventricular assist device