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J Thorac Cardiovasc Surg. 2010 Jul;140(1):169-73. doi: 10.1016/j.jtcvs.2010.03.026. Epub 2010 May 7.

The impact of bridge-to-transplant ventricular assist device support on survival after cardiac transplantation.

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  • 1Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA. david.bull@hsc.utah.edu

Abstract

OBJECTIVE:

To determine the impact of bridge-to-transplant ventricular assist device support on survival after cardiac transplantation.

METHODS:

From January 1, 1993, to April 30, 2009, a total of 525 cardiac transplants were performed. Ventricular assist devices were placed as a bridge to transplant in 110 patients. We focused our analysis on the 2 most common causes of end-stage heart failure requiring transplantation: idiopathic dilated cardiomyopathy (n = 201) and coronary artery disease (n = 213). Data including gender, age, date of transplant, cause of heart failure, prior heart transplant, placement of a ventricular assist device, type of ventricular assist device, and panel-reactive antibody sensitization were analyzed to derive Kaplan-Meier survival probabilities and multivariable Cox regression models.

RESULTS:

In patients with idiopathic dilated cardiomyopathy who received a ventricular assist device as a bridge to transplant, survival was decreased at 1 year (P = .008) and 5 years (P = .019), but not at 10 years, posttransplant. In patients with coronary artery disease, the use of a ventricular assist device as a bridge to transplant did not influence survival at 1, 5, and 10 tears posttransplant. In patients with idiopathic dilated cardiomyopathy who received a Heartmate I (Thoratec Corp, Pleasanton, Calif) ventricular assist device as a bridge to a cardiac transplant, elevation in the pretransplant panel-reactive antibody correlated with a decrease in long-term survival.

CONCLUSION:

In patients with idiopathic dilated cardiomyopathy, placement of a Heartmate I ventricular assist device as a bridge to a cardiac transplant is associated with an elevation in the pretransplant panel-reactive antibody and a decrease in 1- and 5-year survivals after cardiac transplantation.

2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

PMID:
20451930
[PubMed - indexed for MEDLINE]
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