title: Prolonged continuous-flow left ventricular assist device support and posttransplantation outcomes: A new challenge.
abstract: OBJECTIVE
  To assess outcomes after cardiac transplantation in patients receiving long-term continuous-flow left ventricular assist device (CF-LVAD) support.
  
  
  METHODS
  The United Network of Organ Sharing Database was used to identify 7808 heart transplant recipients between January 2011 and March 2014, 2456 (31.5%) of whom were bridged with CF-LVAD. Recipients were stratified by CF-LVAD duration: group 1, <1 year (n = 1590; 64.7%); group 2, 1 to 2 years (n = 599; 24.4%); and group 3, >2 years (n = 267; 10.9%).
  
  
  RESULTS
  Compared with patients in groups 1 and 2, patients in group 3 spent more time as status 1A, had a greater body mass index and higher serum creatinine level, more often received blood transfusions and antibiotics, and more often developed device-related infection and life-threatening arrhythmia before transplantation. Kaplan-Meier analysis revealed statistically significant lower survival rates in group 3 compared with groups 1 and 2, at both 30 days (92.9% vs 96.4% vs 95.5%; group 1 vs group 3, P = .009) and 2 years (78.9% vs 88.2% vs 86.3%; group 1 vs group 3, P = .001) posttransplantation. Multivariable analyses identified duration of CF-LVAD support as a significant factor for 2-year posttransplantation mortality (hazard ratio, 1.16; 95% confidence interval, 1.01-1.34; P = .040).
  
  
  CONCLUSIONS
  A bridge-to-transplant (BTT) strategy with a CF-LVAD has become standard care for patients with advanced heart failure. Duration of CF-LVAD support is associated with increased midterm mortality, warranting early transplantation in the modern BTT era.
authors.affiliation: Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Fukuhara
authors.affiliation: Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Polanco
authors.affiliation: Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY. Electronic address: yn33@cumc.columbia.edu.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D014850:Waiting Lists