Late right heart failure during support with continuous-flow left ventricular assist devices adversely affects post-transplant outcome

Koji Takeda, Hiroo Takayama, Paolo C. Colombo, Ulrich P. Jorde, Melana Yuzefpolskaya, Shinichi Fukuhara, Donna M. Mancini, Yoshifumi Naka

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

BACKGROUND: Right heart failure (RHF) is an unresolved issue during continuous-flow left ventricular assist device (LVAD) support. Little is known about post-transplant outcomes in patients complicated by late RHF during LVAD support. METHODS: Between May 2004 and December 2013, 141 patients underwent cardiac transplantation after isolated LVAD bridging at our center. Late RHF was defined as heart failure requiring medical intervention >4 weeks after LVAD implantation. RESULTS: The patients' mean age was 53 ± 13 years, 82% were men, and 36% had an ischemic etiology. The mean duration of LVAD support before transplantation was 0.75 years. Late RHF developed in 21 patients (15%) during LVAD support. Of these patients, 11 were supported with inotropic agents at the time of transplantation. Patients with RHF had higher creatinine (1.6 ± 0.88 mg/dL vs 1.3 ± 0.67 mg/dL, p = 0.07), higher blood urea nitrogen (32 ± 17 mg/dL vs 24 ± 10 mg/dL, p = 0.0013), higher total bilirubin (0.96 ± 0.46 mg/dL vs 0.78 ± 0.42 mg/dL, p = 0.07), and lower albumin (3.8 ± 0.60 g/dL vs 4.1 ± 0.46 g/dL, p = 0.0019) at the time of transplantation compared with patients who did not develop RHF. In-hospital mortality was significantly higher in patients with late RHF during LVAD support (29% vs 6.7%, p = 0.002). Overall post-transplant survival rates were 87% at 1 year, 83% at 3 years, and 77% at 5 years. The 5-year post-transplant survival was significantly worse in patients who developed late RHF during LVAD support compared with survival in patients who did not develop RHF (26% vs 87%, p < 0.0001). CONCLUSIONS: Late RHF during LVAD support adversely affects post-transplant survival.

Original languageEnglish (US)
Pages (from-to)667-674
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number5
DOIs
StatePublished - 2015
Externally publishedYes

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Heart-Assist Devices
Heart Failure
Transplants
Transplantation
Blood Urea Nitrogen
Patient Rights
Heart Transplantation
Hospital Mortality
Bilirubin
Albumins
Creatinine
Survival Rate

Keywords

  • Continuous flow
  • Right heart failure
  • Survival
  • Transplantation
  • Ventricular assist device

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Late right heart failure during support with continuous-flow left ventricular assist devices adversely affects post-transplant outcome. / Takeda, Koji; Takayama, Hiroo; Colombo, Paolo C.; Jorde, Ulrich P.; Yuzefpolskaya, Melana; Fukuhara, Shinichi; Mancini, Donna M.; Naka, Yoshifumi.

In: Journal of Heart and Lung Transplantation, Vol. 34, No. 5, 2015, p. 667-674.

Research output: Contribution to journalArticle

Takeda, Koji ; Takayama, Hiroo ; Colombo, Paolo C. ; Jorde, Ulrich P. ; Yuzefpolskaya, Melana ; Fukuhara, Shinichi ; Mancini, Donna M. ; Naka, Yoshifumi. / Late right heart failure during support with continuous-flow left ventricular assist devices adversely affects post-transplant outcome. In: Journal of Heart and Lung Transplantation. 2015 ; Vol. 34, No. 5. pp. 667-674.
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abstract = "BACKGROUND: Right heart failure (RHF) is an unresolved issue during continuous-flow left ventricular assist device (LVAD) support. Little is known about post-transplant outcomes in patients complicated by late RHF during LVAD support. METHODS: Between May 2004 and December 2013, 141 patients underwent cardiac transplantation after isolated LVAD bridging at our center. Late RHF was defined as heart failure requiring medical intervention >4 weeks after LVAD implantation. RESULTS: The patients' mean age was 53 ± 13 years, 82{\%} were men, and 36{\%} had an ischemic etiology. The mean duration of LVAD support before transplantation was 0.75 years. Late RHF developed in 21 patients (15{\%}) during LVAD support. Of these patients, 11 were supported with inotropic agents at the time of transplantation. Patients with RHF had higher creatinine (1.6 ± 0.88 mg/dL vs 1.3 ± 0.67 mg/dL, p = 0.07), higher blood urea nitrogen (32 ± 17 mg/dL vs 24 ± 10 mg/dL, p = 0.0013), higher total bilirubin (0.96 ± 0.46 mg/dL vs 0.78 ± 0.42 mg/dL, p = 0.07), and lower albumin (3.8 ± 0.60 g/dL vs 4.1 ± 0.46 g/dL, p = 0.0019) at the time of transplantation compared with patients who did not develop RHF. In-hospital mortality was significantly higher in patients with late RHF during LVAD support (29{\%} vs 6.7{\%}, p = 0.002). Overall post-transplant survival rates were 87{\%} at 1 year, 83{\%} at 3 years, and 77{\%} at 5 years. The 5-year post-transplant survival was significantly worse in patients who developed late RHF during LVAD support compared with survival in patients who did not develop RHF (26{\%} vs 87{\%}, p < 0.0001). CONCLUSIONS: Late RHF during LVAD support adversely affects post-transplant survival.",
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T1 - Late right heart failure during support with continuous-flow left ventricular assist devices adversely affects post-transplant outcome

AU - Takeda, Koji

AU - Takayama, Hiroo

AU - Colombo, Paolo C.

AU - Jorde, Ulrich P.

AU - Yuzefpolskaya, Melana

AU - Fukuhara, Shinichi

AU - Mancini, Donna M.

AU - Naka, Yoshifumi

PY - 2015

Y1 - 2015

N2 - BACKGROUND: Right heart failure (RHF) is an unresolved issue during continuous-flow left ventricular assist device (LVAD) support. Little is known about post-transplant outcomes in patients complicated by late RHF during LVAD support. METHODS: Between May 2004 and December 2013, 141 patients underwent cardiac transplantation after isolated LVAD bridging at our center. Late RHF was defined as heart failure requiring medical intervention >4 weeks after LVAD implantation. RESULTS: The patients' mean age was 53 ± 13 years, 82% were men, and 36% had an ischemic etiology. The mean duration of LVAD support before transplantation was 0.75 years. Late RHF developed in 21 patients (15%) during LVAD support. Of these patients, 11 were supported with inotropic agents at the time of transplantation. Patients with RHF had higher creatinine (1.6 ± 0.88 mg/dL vs 1.3 ± 0.67 mg/dL, p = 0.07), higher blood urea nitrogen (32 ± 17 mg/dL vs 24 ± 10 mg/dL, p = 0.0013), higher total bilirubin (0.96 ± 0.46 mg/dL vs 0.78 ± 0.42 mg/dL, p = 0.07), and lower albumin (3.8 ± 0.60 g/dL vs 4.1 ± 0.46 g/dL, p = 0.0019) at the time of transplantation compared with patients who did not develop RHF. In-hospital mortality was significantly higher in patients with late RHF during LVAD support (29% vs 6.7%, p = 0.002). Overall post-transplant survival rates were 87% at 1 year, 83% at 3 years, and 77% at 5 years. The 5-year post-transplant survival was significantly worse in patients who developed late RHF during LVAD support compared with survival in patients who did not develop RHF (26% vs 87%, p < 0.0001). CONCLUSIONS: Late RHF during LVAD support adversely affects post-transplant survival.

AB - BACKGROUND: Right heart failure (RHF) is an unresolved issue during continuous-flow left ventricular assist device (LVAD) support. Little is known about post-transplant outcomes in patients complicated by late RHF during LVAD support. METHODS: Between May 2004 and December 2013, 141 patients underwent cardiac transplantation after isolated LVAD bridging at our center. Late RHF was defined as heart failure requiring medical intervention >4 weeks after LVAD implantation. RESULTS: The patients' mean age was 53 ± 13 years, 82% were men, and 36% had an ischemic etiology. The mean duration of LVAD support before transplantation was 0.75 years. Late RHF developed in 21 patients (15%) during LVAD support. Of these patients, 11 were supported with inotropic agents at the time of transplantation. Patients with RHF had higher creatinine (1.6 ± 0.88 mg/dL vs 1.3 ± 0.67 mg/dL, p = 0.07), higher blood urea nitrogen (32 ± 17 mg/dL vs 24 ± 10 mg/dL, p = 0.0013), higher total bilirubin (0.96 ± 0.46 mg/dL vs 0.78 ± 0.42 mg/dL, p = 0.07), and lower albumin (3.8 ± 0.60 g/dL vs 4.1 ± 0.46 g/dL, p = 0.0019) at the time of transplantation compared with patients who did not develop RHF. In-hospital mortality was significantly higher in patients with late RHF during LVAD support (29% vs 6.7%, p = 0.002). Overall post-transplant survival rates were 87% at 1 year, 83% at 3 years, and 77% at 5 years. The 5-year post-transplant survival was significantly worse in patients who developed late RHF during LVAD support compared with survival in patients who did not develop RHF (26% vs 87%, p < 0.0001). CONCLUSIONS: Late RHF during LVAD support adversely affects post-transplant survival.

KW - Continuous flow

KW - Right heart failure

KW - Survival

KW - Transplantation

KW - Ventricular assist device

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