Changing outcomes in patients bridged to heart transplantation with continuous-versus pulsatile-flow ventricular assist devices: An analysis of the registry of the international society for heart and lung transplantation

Jose N. Nativi, Stavros G. Drakos, Anna Y. Kucheryavaya, Leah B. Edwards, Craig H. Selzman, David O. Taylor, Marshall I Hertz, Abdallah G. Kfoury, Josef Stehlik

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: Patients bridged to heart transplantation with left ventricular assist devices (LVADs) have been reported to have higher post-transplant mortality compared with those without LVADs. Our aim was to determine the impact of the type of LVAD and implant era on post-transplant survival. Methods: In this study we included 8,557 patients from the registry of the International Society for Heart and Lung Transplantation. We examined post-transplant outcomes in 1,100 patients bridged to transplant with pulsatile-flow LVADs between January 2000 and June 2004 (first era), 880 patients bridged with pulsatile-flow LVADs between July 2004 and May 2008 (second era), and 417 patients bridged with continuous-flow LVADs in the second era. Patients who required intravenous inotropes but not LVAD support (n = 2,728) and patients who did not require either LVAD or inotropes (n = 3,432) served as controls. Results: Post-transplant survival of patients bridged with pulsatile LVADs improved significantly between the first and the second era (p = 0.03). In the second era, there was no significant difference in post-transplant survival of patients bridged with pulsatile- vs continuous-flow LVADs (p = 0.26), and survival rates in the 2 groups were not statistically different from that of the non-LVAD group. Graft rejection was similar in patients bridged with LVADs compared to those without LVADs. Conclusions: In the most recent era, the use of either pulsatile- or continuous-flow LVADs did not result in increased post-transplant mortality. This finding is important as the proportion of patients with LVADs at the time of transplant has been rising.

Original languageEnglish (US)
Pages (from-to)854-861
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume30
Issue number8
DOIs
StatePublished - Aug 1 2011

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Heart-Lung Transplantation
Pulsatile Flow
Heart-Assist Devices
Heart Transplantation
Registries
Transplants
Mortality
Graft Rejection

Keywords

  • assist device
  • heart transplantation
  • mechanical support
  • survival

Cite this

Changing outcomes in patients bridged to heart transplantation with continuous-versus pulsatile-flow ventricular assist devices : An analysis of the registry of the international society for heart and lung transplantation. / Nativi, Jose N.; Drakos, Stavros G.; Kucheryavaya, Anna Y.; Edwards, Leah B.; Selzman, Craig H.; Taylor, David O.; Hertz, Marshall I; Kfoury, Abdallah G.; Stehlik, Josef.

In: Journal of Heart and Lung Transplantation, Vol. 30, No. 8, 01.08.2011, p. 854-861.

Research output: Contribution to journalArticle

Nativi, Jose N. ; Drakos, Stavros G. ; Kucheryavaya, Anna Y. ; Edwards, Leah B. ; Selzman, Craig H. ; Taylor, David O. ; Hertz, Marshall I ; Kfoury, Abdallah G. ; Stehlik, Josef. / Changing outcomes in patients bridged to heart transplantation with continuous-versus pulsatile-flow ventricular assist devices : An analysis of the registry of the international society for heart and lung transplantation. In: Journal of Heart and Lung Transplantation. 2011 ; Vol. 30, No. 8. pp. 854-861.
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abstract = "Background: Patients bridged to heart transplantation with left ventricular assist devices (LVADs) have been reported to have higher post-transplant mortality compared with those without LVADs. Our aim was to determine the impact of the type of LVAD and implant era on post-transplant survival. Methods: In this study we included 8,557 patients from the registry of the International Society for Heart and Lung Transplantation. We examined post-transplant outcomes in 1,100 patients bridged to transplant with pulsatile-flow LVADs between January 2000 and June 2004 (first era), 880 patients bridged with pulsatile-flow LVADs between July 2004 and May 2008 (second era), and 417 patients bridged with continuous-flow LVADs in the second era. Patients who required intravenous inotropes but not LVAD support (n = 2,728) and patients who did not require either LVAD or inotropes (n = 3,432) served as controls. Results: Post-transplant survival of patients bridged with pulsatile LVADs improved significantly between the first and the second era (p = 0.03). In the second era, there was no significant difference in post-transplant survival of patients bridged with pulsatile- vs continuous-flow LVADs (p = 0.26), and survival rates in the 2 groups were not statistically different from that of the non-LVAD group. Graft rejection was similar in patients bridged with LVADs compared to those without LVADs. Conclusions: In the most recent era, the use of either pulsatile- or continuous-flow LVADs did not result in increased post-transplant mortality. This finding is important as the proportion of patients with LVADs at the time of transplant has been rising.",
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T1 - Changing outcomes in patients bridged to heart transplantation with continuous-versus pulsatile-flow ventricular assist devices

T2 - An analysis of the registry of the international society for heart and lung transplantation

AU - Nativi, Jose N.

AU - Drakos, Stavros G.

AU - Kucheryavaya, Anna Y.

AU - Edwards, Leah B.

AU - Selzman, Craig H.

AU - Taylor, David O.

AU - Hertz, Marshall I

AU - Kfoury, Abdallah G.

AU - Stehlik, Josef

PY - 2011/8/1

Y1 - 2011/8/1

N2 - Background: Patients bridged to heart transplantation with left ventricular assist devices (LVADs) have been reported to have higher post-transplant mortality compared with those without LVADs. Our aim was to determine the impact of the type of LVAD and implant era on post-transplant survival. Methods: In this study we included 8,557 patients from the registry of the International Society for Heart and Lung Transplantation. We examined post-transplant outcomes in 1,100 patients bridged to transplant with pulsatile-flow LVADs between January 2000 and June 2004 (first era), 880 patients bridged with pulsatile-flow LVADs between July 2004 and May 2008 (second era), and 417 patients bridged with continuous-flow LVADs in the second era. Patients who required intravenous inotropes but not LVAD support (n = 2,728) and patients who did not require either LVAD or inotropes (n = 3,432) served as controls. Results: Post-transplant survival of patients bridged with pulsatile LVADs improved significantly between the first and the second era (p = 0.03). In the second era, there was no significant difference in post-transplant survival of patients bridged with pulsatile- vs continuous-flow LVADs (p = 0.26), and survival rates in the 2 groups were not statistically different from that of the non-LVAD group. Graft rejection was similar in patients bridged with LVADs compared to those without LVADs. Conclusions: In the most recent era, the use of either pulsatile- or continuous-flow LVADs did not result in increased post-transplant mortality. This finding is important as the proportion of patients with LVADs at the time of transplant has been rising.

AB - Background: Patients bridged to heart transplantation with left ventricular assist devices (LVADs) have been reported to have higher post-transplant mortality compared with those without LVADs. Our aim was to determine the impact of the type of LVAD and implant era on post-transplant survival. Methods: In this study we included 8,557 patients from the registry of the International Society for Heart and Lung Transplantation. We examined post-transplant outcomes in 1,100 patients bridged to transplant with pulsatile-flow LVADs between January 2000 and June 2004 (first era), 880 patients bridged with pulsatile-flow LVADs between July 2004 and May 2008 (second era), and 417 patients bridged with continuous-flow LVADs in the second era. Patients who required intravenous inotropes but not LVAD support (n = 2,728) and patients who did not require either LVAD or inotropes (n = 3,432) served as controls. Results: Post-transplant survival of patients bridged with pulsatile LVADs improved significantly between the first and the second era (p = 0.03). In the second era, there was no significant difference in post-transplant survival of patients bridged with pulsatile- vs continuous-flow LVADs (p = 0.26), and survival rates in the 2 groups were not statistically different from that of the non-LVAD group. Graft rejection was similar in patients bridged with LVADs compared to those without LVADs. Conclusions: In the most recent era, the use of either pulsatile- or continuous-flow LVADs did not result in increased post-transplant mortality. This finding is important as the proportion of patients with LVADs at the time of transplant has been rising.

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