title: Outcomes in Patients Bridged With Univentricular and Biventricular Devices in the Modern Era of Heart Transplantation.
abstract: BACKGROUND
  Biventricular support before orthotopic heart transplantation (OHT) has been shown to adversely affect short- and long-term outcomes, but the comparative effect of support type is largely unknown. This study determined the comparative effect of univentricular and biventricular support on survival in bridged patients after OHT.
  
  
  METHODS
  The United Network of Organ Sharing database was queried for adult patients bridged to OHT with a univentricular (left ventricular assist device [LVAD]), biventricular (biventricular assist device [BiVAD]), or total artificial heart ([TAH]) device between 2004 and 2012. Unconditional and conditional survivals were compared with the Kaplan-Meier method. Cox proportional hazards regression models were constructed to determine the risk-adjusted influence of support type on death.
  
  
  RESULTS
  Of the 4,177 patients identified, 3,457 (20.4%), 575 (3.4%), and 145 (0.9%) were bridged with an LVAD, BiVAD, and TAH, respectively. Unadjusted 30-day, 1-year, and 5-year estimated survival was greater in LVAD patients than in the BiVAD and TAH cohorts. After risk-adjustment, BiVAD and TAH were associated with an increased risk of death at all time points. Unadjusted and adjusted 5-year survival, conditional on 1-year survival, was worse, however, in only TAH patients.
  
  
  CONCLUSIONS
  Patients with biventricular failure bridged to OHT with a TAH or BiVAD experience worse short- and long-term survival comparison with those with an LVAD. This difference is most likely due to an increase in early death and depends on the type of BiVAD device implanted.
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Grimm
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Sciortino
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: J Trent
authors.initials: JT
authors.lastname: Magruder
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Samuel P
authors.initials: SP
authors.lastname: Dungan
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Vicente
authors.initials: V
authors.lastname: Valero
authors.affiliation: Divison of Cardiology, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Kavita
authors.initials: K
authors.lastname: Sharma
authors.affiliation: Divison of Cardiology, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Tedford
authors.affiliation: Divison of Cardiology, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Russell
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Glenn J R
authors.initials: GJ
authors.lastname: Whitman
authors.affiliation: Division of Cardiothoracic Surgery, Florida Hospital, Orlando, Florida.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Silvestry
authors.affiliation: Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: ashah29@jhmi.edu.
authors.forename: Ashish S
authors.initials: AS
authors.lastname: Shah
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists / Q000401:mortality*