Lack of sensitization and equivalent post-transplant outcomes with the novacor left ventricular assist device

David A. Baran, Alan L. Gass, Ira D. Galin, Mark J. Zucker, Luis H. Arroyo, Daniel J. Goldstein, Thomas Prendergast, Steven Lubitz, Mary C. Courtney, Rhodora Correa, Ming Chan, David Spielvogel, Steven L. Lansman

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Ventricular assist devices (VADs) are increasingly used to support critically ill heart failure patients awaiting transplantation. Previous work has focused on the Thoratec Heartmate VE device, use of which is associated with pre-formed antibody production. We reviewed our cumulative experience with the Worldheart Novacor VAD as a bridge to transplantation (BTT). Methods: From January 1989 through October 2002, 39 patients required a VAD bridge, with 26 of 39 surviving to transplantation. Antibody levels were assessed by complement-dependent cytotoxicity assay at routine intervals and expressed as panel reactive antibody (PRA) levels. Post-transplant allograft rejection, coronary vasculopathy, and survival were compared between Novacor-supported patients and non-VAD transplant recipients. Results: PRA values did not significantly change after VAD implantation (12.4% ± 11.2% vs 14.8% ± 12.3%, p = 0.28). Survival for the BTT patients was 80.4%, 75.7%, 64.0%, 64.0%, and 64.0%, respectively, for 1, 3, 5, 7, and 10 years post-transplant, with similar results for non-BTT patients. The freedom from coronary vasculopathy was 90.2%, 90.2%, 72.2%, and 72.2%, respectively, at 1, 3, 5, and 7 years post-transplant. Conclusions: First, to our knowledge, this study is the first to examine the incidence of allosensitization after Novacor implant in detail. In contrast with previous results of work with other VAD systems, as assessed by PRA levels, Novacor patients did not become sensitized. Second, compared with 220 non-BTT patients who received transplants during a similar time frame, Novacor BTT patients had equivalent rejection profiles and survival. Finally, the incidence of transplant-associated coronary artery disease was lower than in previous reports.

Original languageEnglish (US)
Pages (from-to)1886-1890
Number of pages5
JournalJournal of Heart and Lung Transplantation
Volume24
Issue number11
DOIs
StatePublished - Nov 2005
Externally publishedYes

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Heart-Assist Devices
Transplantation
Transplants
Antibodies
Survival
Equipment and Supplies
Incidence
Graft Rejection
Critical Illness
Antibody Formation
Allografts
Coronary Artery Disease
Heart Failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Lack of sensitization and equivalent post-transplant outcomes with the novacor left ventricular assist device. / Baran, David A.; Gass, Alan L.; Galin, Ira D.; Zucker, Mark J.; Arroyo, Luis H.; Goldstein, Daniel J.; Prendergast, Thomas; Lubitz, Steven; Courtney, Mary C.; Correa, Rhodora; Chan, Ming; Spielvogel, David; Lansman, Steven L.

In: Journal of Heart and Lung Transplantation, Vol. 24, No. 11, 11.2005, p. 1886-1890.

Research output: Contribution to journalArticle

Baran, DA, Gass, AL, Galin, ID, Zucker, MJ, Arroyo, LH, Goldstein, DJ, Prendergast, T, Lubitz, S, Courtney, MC, Correa, R, Chan, M, Spielvogel, D & Lansman, SL 2005, 'Lack of sensitization and equivalent post-transplant outcomes with the novacor left ventricular assist device', Journal of Heart and Lung Transplantation, vol. 24, no. 11, pp. 1886-1890. https://doi.org/10.1016/j.healun.2005.03.010
Baran, David A. ; Gass, Alan L. ; Galin, Ira D. ; Zucker, Mark J. ; Arroyo, Luis H. ; Goldstein, Daniel J. ; Prendergast, Thomas ; Lubitz, Steven ; Courtney, Mary C. ; Correa, Rhodora ; Chan, Ming ; Spielvogel, David ; Lansman, Steven L. / Lack of sensitization and equivalent post-transplant outcomes with the novacor left ventricular assist device. In: Journal of Heart and Lung Transplantation. 2005 ; Vol. 24, No. 11. pp. 1886-1890.
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abstract = "Background: Ventricular assist devices (VADs) are increasingly used to support critically ill heart failure patients awaiting transplantation. Previous work has focused on the Thoratec Heartmate VE device, use of which is associated with pre-formed antibody production. We reviewed our cumulative experience with the Worldheart Novacor VAD as a bridge to transplantation (BTT). Methods: From January 1989 through October 2002, 39 patients required a VAD bridge, with 26 of 39 surviving to transplantation. Antibody levels were assessed by complement-dependent cytotoxicity assay at routine intervals and expressed as panel reactive antibody (PRA) levels. Post-transplant allograft rejection, coronary vasculopathy, and survival were compared between Novacor-supported patients and non-VAD transplant recipients. Results: PRA values did not significantly change after VAD implantation (12.4{\%} ± 11.2{\%} vs 14.8{\%} ± 12.3{\%}, p = 0.28). Survival for the BTT patients was 80.4{\%}, 75.7{\%}, 64.0{\%}, 64.0{\%}, and 64.0{\%}, respectively, for 1, 3, 5, 7, and 10 years post-transplant, with similar results for non-BTT patients. The freedom from coronary vasculopathy was 90.2{\%}, 90.2{\%}, 72.2{\%}, and 72.2{\%}, respectively, at 1, 3, 5, and 7 years post-transplant. Conclusions: First, to our knowledge, this study is the first to examine the incidence of allosensitization after Novacor implant in detail. In contrast with previous results of work with other VAD systems, as assessed by PRA levels, Novacor patients did not become sensitized. Second, compared with 220 non-BTT patients who received transplants during a similar time frame, Novacor BTT patients had equivalent rejection profiles and survival. Finally, the incidence of transplant-associated coronary artery disease was lower than in previous reports.",
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AU - Gass, Alan L.

AU - Galin, Ira D.

AU - Zucker, Mark J.

AU - Arroyo, Luis H.

AU - Goldstein, Daniel J.

AU - Prendergast, Thomas

AU - Lubitz, Steven

AU - Courtney, Mary C.

AU - Correa, Rhodora

AU - Chan, Ming

AU - Spielvogel, David

AU - Lansman, Steven L.

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N2 - Background: Ventricular assist devices (VADs) are increasingly used to support critically ill heart failure patients awaiting transplantation. Previous work has focused on the Thoratec Heartmate VE device, use of which is associated with pre-formed antibody production. We reviewed our cumulative experience with the Worldheart Novacor VAD as a bridge to transplantation (BTT). Methods: From January 1989 through October 2002, 39 patients required a VAD bridge, with 26 of 39 surviving to transplantation. Antibody levels were assessed by complement-dependent cytotoxicity assay at routine intervals and expressed as panel reactive antibody (PRA) levels. Post-transplant allograft rejection, coronary vasculopathy, and survival were compared between Novacor-supported patients and non-VAD transplant recipients. Results: PRA values did not significantly change after VAD implantation (12.4% ± 11.2% vs 14.8% ± 12.3%, p = 0.28). Survival for the BTT patients was 80.4%, 75.7%, 64.0%, 64.0%, and 64.0%, respectively, for 1, 3, 5, 7, and 10 years post-transplant, with similar results for non-BTT patients. The freedom from coronary vasculopathy was 90.2%, 90.2%, 72.2%, and 72.2%, respectively, at 1, 3, 5, and 7 years post-transplant. Conclusions: First, to our knowledge, this study is the first to examine the incidence of allosensitization after Novacor implant in detail. In contrast with previous results of work with other VAD systems, as assessed by PRA levels, Novacor patients did not become sensitized. Second, compared with 220 non-BTT patients who received transplants during a similar time frame, Novacor BTT patients had equivalent rejection profiles and survival. Finally, the incidence of transplant-associated coronary artery disease was lower than in previous reports.

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