Outcome of cardiac transplantation in patients requiring prolonged continuous-flow left ventricular assist device support

Koji Takeda, Hiroo Takayama, Bindu Kalesan, Nir Uriel, Paolo C. Colombo, Ulrich P. Jorde, Melana Yuzefpolskaya, Donna M. Mancini, Yoshifumi Naka

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objective This study assessed the early and late outcomes after cardiac transplantation in patients receiving long-term continuous-flow left ventricular assist device (CF-LVAD) support.

Methods Between April 2004 and September 2013, 192 patients underwent HeartMate II (Thoratec, Pleasanton, CA) CF-LVAD placement as a bridge to transplant at our center. Of these, 122 (63%) successfully bridged patients were retrospectively reviewed. Patients were stratified into 2 groups according to their waiting time with CF-LVAD support of <1 year or ≥1 year.

Results The study cohort was a mean age of 54 ± 13 years, 79% were male, and 35% had an ischemic etiology. The mean duration of CF-LVAD support before transplantation was 296 days (range, 27-1,413 days). The overall 30-day mortality was 4.1%. Overall post-transplant survival was 88%, 84%, 78% at 1, 3, and 5 years, respectively. The 32 patients (26%) with ≥1 year of CF-LVAD support (mean, 635 days) were more likely to have blood type O, a larger body size, and to have been readmitted due to recurrent heart failure and device failure requiring exchange than those with <1 year of CF-LVAD support. Patients who required prolonged support time also had worse in-hospital mortality (16% vs 6.7%, p = 0.12) and significantly lower survival at 3 years after transplantation (68% vs 88%, p = 0.049).

Conclusions The overall short-term and long-term cardiac transplant outcomes of patients supported with CF-LVAD are satisfactory. However, patients who require prolonged CF-LVAD support may have diminished post-transplant survival due to adverse events occurring during device support.

Original languageEnglish (US)
Pages (from-to)89-99
Number of pages11
JournalJournal of Heart and Lung Transplantation
Volume34
Issue number1
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Heart-Assist Devices
Heart Transplantation
Transplants
Transplantation
Equipment Failure
Body Size
Hospital Mortality
Cohort Studies
Heart Failure
Equipment and Supplies
Survival
Mortality

Keywords

  • continuous flow
  • KeyWords ventricular assist device
  • long-term
  • outcome
  • transplant

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery
  • Medicine(all)

Cite this

Outcome of cardiac transplantation in patients requiring prolonged continuous-flow left ventricular assist device support. / Takeda, Koji; Takayama, Hiroo; Kalesan, Bindu; Uriel, Nir; Colombo, Paolo C.; Jorde, Ulrich P.; Yuzefpolskaya, Melana; Mancini, Donna M.; Naka, Yoshifumi.

In: Journal of Heart and Lung Transplantation, Vol. 34, No. 1, 01.01.2015, p. 89-99.

Research output: Contribution to journalArticle

Takeda, Koji ; Takayama, Hiroo ; Kalesan, Bindu ; Uriel, Nir ; Colombo, Paolo C. ; Jorde, Ulrich P. ; Yuzefpolskaya, Melana ; Mancini, Donna M. ; Naka, Yoshifumi. / Outcome of cardiac transplantation in patients requiring prolonged continuous-flow left ventricular assist device support. In: Journal of Heart and Lung Transplantation. 2015 ; Vol. 34, No. 1. pp. 89-99.
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abstract = "Objective This study assessed the early and late outcomes after cardiac transplantation in patients receiving long-term continuous-flow left ventricular assist device (CF-LVAD) support.Methods Between April 2004 and September 2013, 192 patients underwent HeartMate II (Thoratec, Pleasanton, CA) CF-LVAD placement as a bridge to transplant at our center. Of these, 122 (63{\%}) successfully bridged patients were retrospectively reviewed. Patients were stratified into 2 groups according to their waiting time with CF-LVAD support of <1 year or ≥1 year.Results The study cohort was a mean age of 54 ± 13 years, 79{\%} were male, and 35{\%} had an ischemic etiology. The mean duration of CF-LVAD support before transplantation was 296 days (range, 27-1,413 days). The overall 30-day mortality was 4.1{\%}. Overall post-transplant survival was 88{\%}, 84{\%}, 78{\%} at 1, 3, and 5 years, respectively. The 32 patients (26{\%}) with ≥1 year of CF-LVAD support (mean, 635 days) were more likely to have blood type O, a larger body size, and to have been readmitted due to recurrent heart failure and device failure requiring exchange than those with <1 year of CF-LVAD support. Patients who required prolonged support time also had worse in-hospital mortality (16{\%} vs 6.7{\%}, p = 0.12) and significantly lower survival at 3 years after transplantation (68{\%} vs 88{\%}, p = 0.049).Conclusions The overall short-term and long-term cardiac transplant outcomes of patients supported with CF-LVAD are satisfactory. However, patients who require prolonged CF-LVAD support may have diminished post-transplant survival due to adverse events occurring during device support.",
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AU - Takeda, Koji

AU - Takayama, Hiroo

AU - Kalesan, Bindu

AU - Uriel, Nir

AU - Colombo, Paolo C.

AU - Jorde, Ulrich P.

AU - Yuzefpolskaya, Melana

AU - Mancini, Donna M.

AU - Naka, Yoshifumi

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N2 - Objective This study assessed the early and late outcomes after cardiac transplantation in patients receiving long-term continuous-flow left ventricular assist device (CF-LVAD) support.Methods Between April 2004 and September 2013, 192 patients underwent HeartMate II (Thoratec, Pleasanton, CA) CF-LVAD placement as a bridge to transplant at our center. Of these, 122 (63%) successfully bridged patients were retrospectively reviewed. Patients were stratified into 2 groups according to their waiting time with CF-LVAD support of <1 year or ≥1 year.Results The study cohort was a mean age of 54 ± 13 years, 79% were male, and 35% had an ischemic etiology. The mean duration of CF-LVAD support before transplantation was 296 days (range, 27-1,413 days). The overall 30-day mortality was 4.1%. Overall post-transplant survival was 88%, 84%, 78% at 1, 3, and 5 years, respectively. The 32 patients (26%) with ≥1 year of CF-LVAD support (mean, 635 days) were more likely to have blood type O, a larger body size, and to have been readmitted due to recurrent heart failure and device failure requiring exchange than those with <1 year of CF-LVAD support. Patients who required prolonged support time also had worse in-hospital mortality (16% vs 6.7%, p = 0.12) and significantly lower survival at 3 years after transplantation (68% vs 88%, p = 0.049).Conclusions The overall short-term and long-term cardiac transplant outcomes of patients supported with CF-LVAD are satisfactory. However, patients who require prolonged CF-LVAD support may have diminished post-transplant survival due to adverse events occurring during device support.

AB - Objective This study assessed the early and late outcomes after cardiac transplantation in patients receiving long-term continuous-flow left ventricular assist device (CF-LVAD) support.Methods Between April 2004 and September 2013, 192 patients underwent HeartMate II (Thoratec, Pleasanton, CA) CF-LVAD placement as a bridge to transplant at our center. Of these, 122 (63%) successfully bridged patients were retrospectively reviewed. Patients were stratified into 2 groups according to their waiting time with CF-LVAD support of <1 year or ≥1 year.Results The study cohort was a mean age of 54 ± 13 years, 79% were male, and 35% had an ischemic etiology. The mean duration of CF-LVAD support before transplantation was 296 days (range, 27-1,413 days). The overall 30-day mortality was 4.1%. Overall post-transplant survival was 88%, 84%, 78% at 1, 3, and 5 years, respectively. The 32 patients (26%) with ≥1 year of CF-LVAD support (mean, 635 days) were more likely to have blood type O, a larger body size, and to have been readmitted due to recurrent heart failure and device failure requiring exchange than those with <1 year of CF-LVAD support. Patients who required prolonged support time also had worse in-hospital mortality (16% vs 6.7%, p = 0.12) and significantly lower survival at 3 years after transplantation (68% vs 88%, p = 0.049).Conclusions The overall short-term and long-term cardiac transplant outcomes of patients supported with CF-LVAD are satisfactory. However, patients who require prolonged CF-LVAD support may have diminished post-transplant survival due to adverse events occurring during device support.

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