title: Novel Scoring System to Predict Ineligibility for Bridge to Implantable Left Ventricular Assist Device as Destination Therapy Before Extracorporeal Ventricular Assist Device Implantation - For the Coming Era of Destination Therapy in Japan.
abstract: BACKGROUND
  Although destination therapy (DT) is now expected to be a promising strategy for those who are not suitable for heart transplantation in Japan, there has not been any investigation into ineligibility for bridging to implantable left ventricular assist device (I-LVAD) as DT among patients with extracorporeal LVAD.
  
  
  RESULTS
  We retrospectively studied 85 patients who had received an extracorporeal LVAD. To assess ineligibility for a bridge to I-LVAD for DT, we defined DT ineligibility (DTI) as BiVAD requirement, death within 6 months, and persistent end-organ dysfunction (medium or high J-VAD risk score) at 6 months after extracorporeal LVAD implantation. DTI was recorded for 32 patients. Uni/multivariate analysis showed that smaller left ventricular diastolic dimension (<64 mm; [odds ratio (OR) 4.522]), continuous hemodiafiltration (OR 4.862), past history of cardiac surgery (OR 6.522), and low serum albumin level (<3.1 g/dl; OR 10.064) were significant predictors of DTI. By scoring 2, 2, 3, 4 points, respectively, considering each OR, we constructed a novel scoring system for DTI (DTI score), which stratified patients into 3 risk strata: low (0-3 points), medium (4-6 points), and high (7-11 points), from the view point of DTI risk (low 8%, medium 46%, high 93%, respectively).
  
  
  CONCLUSIONS
  DTI score is a promising tool for predicting ineligibility for I-LVAD as DT before extracorporeal VAD implantation.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nitta
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Imamura
authors.forename: Miyoko
authors.initials: M
authors.lastname: Endo
authors.forename: Toshiro
authors.initials: T
authors.lastname: Inaba
authors.forename: Hisataka
authors.initials: H
authors.lastname: Maki
authors.forename: Eisuke
authors.initials: E
authors.lastname: Amiya
authors.forename: Masaru
authors.initials: M
authors.lastname: Hatano
authors.forename: Osamu
authors.initials: O
authors.lastname: Kinoshita
authors.forename: Kan
authors.initials: K
authors.lastname: Nawata
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D006353:Heart-Assist Devices; D017583:Hemodiafiltration; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D012709:Serum Albumin