title: Assessing Consequences of Intraaortic Balloon Counterpulsation Versus Left Ventricular Assist Devices at the Time of Heart Transplantation.
abstract: The proportion of heart transplant recipients bridged with durable, intracorporeal left ventricular assist devices (dLVADs) has dramatically increased; however, concern exists regarding obligate repeat sternotomy, increased bleeding risk because of anticoagulation and acquired von Willebrand disease, and increased rates of allosensitization. Whether dLVAD patients have impaired posttransplant outcomes compared with equivalent patients with less invasive intraaortic balloon pump counterpulsation (IABP) at the time of transplant is unknown. Therefore, we analyzed adult, first time, heart-only transplant procedures with dLVAD (n = 2,636) compared with IABP (n = 571) at the time of transplant based on data from the United Network for Organ Sharing (UNOS) July 2004 to December 2011. There was clear geographic variation in IABP and dLVAD at transplant. Multivariable analysis demonstrated equivalent cumulative risk of death (adjusted Cox proportional hazard ratio, 1.08; 95% confidence interval, 0.87-1.33; p = 0.51). There was no significant difference in adjusted comparison of perioperative morality, length of stay, postoperative renal failure requiring dialysis, or early acute rejection (p ≥ 0.14 for all). Therefore, data from UNOS suggest that the presence of dLVAD at the time of heart transplantation does not have a detrimental effect on postoperative outcomes compared with IABP, which must be considered in the context of pretransplant mortality and locoregional organ availability.
authors.affiliation: From the *Department of Surgery, Duke University Medical Center, Durham, North Carolina; †Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina; ‡Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; and §CTI, Clinical Trial and Consulting Services, Raleigh, North Carolina.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Castleberry
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Southerland
authors.forename: James M
authors.initials: JM
authors.lastname: Meza
authors.forename: William D
authors.initials: WD
authors.lastname: Irish
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
authors.forename: Carmelo A
authors.initials: CA
authors.lastname: Milano
authors.forename: Chetan B
authors.initials: CB
authors.lastname: Patel
mesh_terms: D000328:Adult; D005260:Female; D016027:Heart Transplantation / Q000379:methods*; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models