Duration of Left Ventricular Assist Device Support Does Not Impact Survival After US Heart Transplantation.
BACKGROUND
The aim of this study was to determine whether the duration of left ventricular device support (LVAD) influenced outcomes after orthotopic heart transplantation in a modern, bridge to transplant national cohort.


METHODS
The United Network for Organ Sharing database, which has recently made pretransplant LVAD duration available, was queried for all adult bridge to transplant patients between January 2011 and December 2012. Three LVAD duration cohorts were generated, as follows: short (less than 90 days), intermediate (90 to 365 days), and prolonged (more than 365 days). Recipient, donor, and transplant-specific characteristics were compared among the duration cohorts. Unadjusted short-term and long-term survivals were estimated with the Kaplan-Meier method. Risk-adjusted models were also constructed to determine the independent impact of device duration on mortality.


RESULTS
Of the 1,332 patients who met criteria for inclusion, 9.8% (n = 130), 54.7% (n = 729), and 35.5% (n = 473) were classified as short, intermediate, and prolonged, respectively. Although the performance status across each cohort was similar at listing (p = 0.38), more patients in the intermediate and prolonged cohorts were considered functionally independent before orthotopic heart transplantation (32% and 37%, respectively, versus 18%; p < 0.001). Additionally, despite worse baseline renal function in the intermediate and prolonged cohorts relative to the short cohort (glomerular filtration rate, 57 and 57 versus 69, p < 0.001), there was no difference in the incidence of new onset posttransplant renal failure (7% versus 10%, 9%, p = 0.41). There was also no difference in 30-day survival (98%, 96%, 95%, p = 0.51), 6-month survival (93%, 92%, 92%, p = 0.93), or 1-year survival (91%, 89%, 89%, p = 0.78) across the cohorts. After risk adjustment, duration did not independently predict mortality at any timepoint.


CONCLUSIONS
In the largest, non-industry sponsored study of a modern bridge to transplant cohort, we demonstrated that duration of LVAD support before orthotopic heart transplantation does not influence posttransplant morbidity or mortality. In subanalysis, support for 90 days or more is associated with improvements in pretransplant functional performance.
Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Joshua C
JC
Grimm
Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
J Trent
JT
Magruder
Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Todd C
TC
Crawford
Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Charles D
CD
Fraser
Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
William G
WG
Plum
Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Christopher M
CM
Sciortino
Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Robert S
RS
Higgins
Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Glenn J R
GJ
Whitman
Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: ashish.s.shah@vanderbilt.edu.
Ashish S
AS
Shah
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D006113:United Kingdom; D014850:Waiting Lists