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Long-term outcome of high-urgency heart transplant patients with and without temporary ventricular assist device support.

Abstract

BACKGROUND

The use of short-term ventricular assist devices (VAD) in patients awaiting high-urgency (HU) heart transplantation (HTx) in Spain has steadily increased due to longer waiting times and the new heart allocation system. It is unknown whether the use of short-term VAD support in patients with cardiogenic shock affects HTx outcome. We sought to investigate long-term outcomes of HU transplanted patients with VAD compared with HU transplanted patients without device support.

METHODS

We retrospectively evaluated all HTx patients transplanted between 1999 and 2011 in our institution. Patients were categorized by urgency: elective HTx, HU-HTx with VAD (status 0), and HU-HTx without VAD (status 1). Actuarial survival rates were compared.

RESULTS

Of 237 transplanted patients, 55 (23%) were HU-HTx, including 16 on VAD support and 39 without VAD. Mean time in the HU waiting list was 6.5 ± 6 days and mean VAD support was 8.4 ± 8 days (range, 1 to 31 days). Assist devices used were Levitronix Centrimag (6), Abiomed (9), and extracorporeal membrane oxygenation (ECMO) (1). After a mean follow-up of 4.6 ± 4.1 years (range 0 to 13 years), 22 patients had died: 5 VAD and 17 non-VAD. The 1- and 5-year survival rates were 73% and 61% for the VAD and 74% and 62% for the non-VAD group, respectively (P = ns). Kaplan-Meier and Cox regression analyses did not show survival differences, HR 1.11 (95% CI 0.41-3.02), P = 0.84. The presence of renal failure was associated with increased mortality risk, HR 1.9 (95% CI 1.1-3.2), P = 0.02. The presence of renal failure was associated with increased mortality risk [HR 1.9 (95% CI 1.1-3.2), P = .02.).

CONCLUSIONS

In our experience, the long-term outcome of patients receiving HU-HTx under short-term VAD support is comparable to that of patients undergoing HU-HTx without VAD support. Patients with renal failure had an increased risk for overall mortality in this set of patients.

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  • Authors+Show Affiliations

    ,

    Cardiology Department, Thorax Clínic Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. macastel@clinic.ub.es

    , , , , , ,

    Source

    Transplantation proceedings 44:9 2012 Nov pg 2642-4

    MeSH

    Adult
    Female
    Heart Failure
    Heart Transplantation
    Heart-Assist Devices
    Humans
    Kaplan-Meier Estimate
    Male
    Middle Aged
    Proportional Hazards Models
    Prosthesis Design
    Registries
    Renal Insufficiency
    Retrospective Studies
    Risk Factors
    Spain
    Survival Rate
    Time Factors
    Treatment Outcome
    Ventricular Function, Left
    Waiting Lists

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    23146481

    Citation

    Castel, M A., et al. "Long-term Outcome of High-urgency Heart Transplant Patients With and Without Temporary Ventricular Assist Device Support." Transplantation Proceedings, vol. 44, no. 9, 2012, pp. 2642-4.
    Castel MA, Cartañá R, Cardona M, et al. Long-term outcome of high-urgency heart transplant patients with and without temporary ventricular assist device support. Transplant Proc. 2012;44(9):2642-4.
    Castel, M. A., Cartañá, R., Cardona, M., Pereda, D., Hernández, M., Sandoval, E., ... Pérez-Villa, F. (2012). Long-term outcome of high-urgency heart transplant patients with and without temporary ventricular assist device support. Transplantation Proceedings, 44(9), pp. 2642-4. doi:10.1016/j.transproceed.2012.09.107.
    Castel MA, et al. Long-term Outcome of High-urgency Heart Transplant Patients With and Without Temporary Ventricular Assist Device Support. Transplant Proc. 2012;44(9):2642-4. PubMed PMID: 23146481.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Long-term outcome of high-urgency heart transplant patients with and without temporary ventricular assist device support. AU - Castel,M A, AU - Cartañá,R, AU - Cardona,M, AU - Pereda,D, AU - Hernández,M, AU - Sandoval,E, AU - Castella,M, AU - Pérez-Villa,F, PY - 2012/11/14/entrez PY - 2012/11/14/pubmed PY - 2013/6/14/medline SP - 2642 EP - 4 JF - Transplantation proceedings JO - Transplant. Proc. VL - 44 IS - 9 N2 - BACKGROUND: The use of short-term ventricular assist devices (VAD) in patients awaiting high-urgency (HU) heart transplantation (HTx) in Spain has steadily increased due to longer waiting times and the new heart allocation system. It is unknown whether the use of short-term VAD support in patients with cardiogenic shock affects HTx outcome. We sought to investigate long-term outcomes of HU transplanted patients with VAD compared with HU transplanted patients without device support. METHODS: We retrospectively evaluated all HTx patients transplanted between 1999 and 2011 in our institution. Patients were categorized by urgency: elective HTx, HU-HTx with VAD (status 0), and HU-HTx without VAD (status 1). Actuarial survival rates were compared. RESULTS: Of 237 transplanted patients, 55 (23%) were HU-HTx, including 16 on VAD support and 39 without VAD. Mean time in the HU waiting list was 6.5 ± 6 days and mean VAD support was 8.4 ± 8 days (range, 1 to 31 days). Assist devices used were Levitronix Centrimag (6), Abiomed (9), and extracorporeal membrane oxygenation (ECMO) (1). After a mean follow-up of 4.6 ± 4.1 years (range 0 to 13 years), 22 patients had died: 5 VAD and 17 non-VAD. The 1- and 5-year survival rates were 73% and 61% for the VAD and 74% and 62% for the non-VAD group, respectively (P = ns). Kaplan-Meier and Cox regression analyses did not show survival differences, HR 1.11 (95% CI 0.41-3.02), P = 0.84. The presence of renal failure was associated with increased mortality risk, HR 1.9 (95% CI 1.1-3.2), P = 0.02. The presence of renal failure was associated with increased mortality risk [HR 1.9 (95% CI 1.1-3.2), P = .02.). CONCLUSIONS: In our experience, the long-term outcome of patients receiving HU-HTx under short-term VAD support is comparable to that of patients undergoing HU-HTx without VAD support. Patients with renal failure had an increased risk for overall mortality in this set of patients. SN - 1873-2623 UR - https://www.unboundmedicine.com/medline/citation/23146481/Long_term_outcome_of_high_urgency_heart_transplant_patients_with_and_without_temporary_ventricular_assist_device_support_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-1345(12)01097-4 DB - PRIME DP - Unbound Medicine ER -