title: The role of implantable cardioverter defibrillators in patients bridged to transplantation with a continuous-flow left ventricular assist device: A propensity score matched analysis.
abstract: BACKGROUND
  Implantable cardioverter defibrillators (ICDs) provide a significant mortality benefit for appropriately selected patients with advanced heart failure. ICDs are associated with a mortality benefit when used in patients with a pulsatile left ventricular assist device (LVAD). It is unclear whether patients with a continuous-flow LVAD (CF-LVAD) derive the same benefit. We sought to determine if the presence of an ICD provided a mortality benefit during CF-LVAD support as a bridge to transplantation.
  
  
  METHODS
  Patients were identified in the United Network for Organ Sharing (UNOS) registry who underwent LVAD implantation as bridge to transplantation between May 2004 and April 2014, with follow-up through June 2014. Primary outcome was freedom from death while on CF-LVAD support with adjustment for complications requiring UNOS listing status upgrade. Secondary end-points included freedom from delisting while on CF-LVAD support and incidence of transplantation.
  
  
  RESULTS
  The study cohort comprised 2,990 patients, and propensity score matching identified 1,012 patients with similar propensity scores. There was no difference in survival during device support between patients with and without an ICD (hazard ratio [HR] = 1.20; 95% confidence interval [CI], 0.66-2.17; p = 0.55). Adjusting for device complications requiring a UNOS listing status upgrade had minimal influence (HR = 1.11; 95% CI, 0.60-2.05; p = 0.74). There was no increased risk of delisting owing to being too sick for patients with an ICD (HR = 1.08; 95% CI, 0.63-1.86; p = 0.78). Likewise, the probability of transplantation was similar (HR = 1.05; 95% CI, 0.87-1.27; p = 0.62).
  
  
  CONCLUSIONS
  Among patients bridged to transplantation with a CF-LVAD, the presence of an ICD did not reduce mortality.
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Clerkin
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Veli K
authors.initials: VK
authors.lastname: Topkara
authors.affiliation: Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Melana
authors.initials: M
authors.lastname: Yuzefpolskaya
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Demmer
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Dizon
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: arg2024@cumc.columbia.edu.
authors.forename: A Reshad
authors.initials: AR
authors.lastname: Garan
mesh_terms: D000328:Adult; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: ICD; LVAD; arrhythmia; cardiac transplant; congestive heart failure