Cardiac transplantation after bridged therapy with continuous flow left ventricular assist devices

Salil V. Deo, Kiick Sung, Richard C. Daly, Ishan K. Shah, Salah E. Altarabsheh, John M. Stulak, Lyle D. Joyce, Barry A. Boilson, Sudhir S. Kushwaha, Soon J. Park

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction: Cardiac transplantation is an effective surgical therapy for end-stage heart failure. Patients (pts) may need to be bridged with a continuous flow left ventricular assist device (CF-LVAD) while on the transplant list as logistic factors like organ availability are unknown. Cardiac transplantation post-LVAD can be a surgically challenging procedure and outcome in these pts is perceived to be poorer based on experience with earlier generation pulsatile flow pumps. Data from a single institution comparing these pts with those undergoing direct transplantation in the present era of continuous flow device therapy are limited. Aim: Evaluate results of cardiac transplantation in pts bridged with a CF-LVAD (BTx) and compare outcomes with pts undergoing direct transplantation (Tx) in a single institution. Results: From June 2007 till January 2012, 106 pts underwent cardiac transplantation. Among these, 37 (35%) pts (51. ±. 11 years; 85% male) were bridged with a CF-LVAD (BTx), while 70 (65%) comprised the Tx group (53. ±. 12 years; 72% males). The median duration of LVAD support was 227 (153,327) days. During the period of LVAD support, 10/37 (27%) pts were upgraded to status 1A and all were successfully transplanted. Median hospital stay in the BTx (14 days) was slightly longer than the Tx group (12 days) but not statistically significant (p= 0.21). In-hospital mortality in the BTx (5%) and Tx (1%) were comparable (p= 0.25). Estimated late survival in the BTx cohort was 94. ±. 7, 90. ±. 10 and 83. ±. 16% at the end of one, two and three years, respectively which was comparable to 97. ±. 4%, 93. ±. 6% and 89. ±. 9% for the Tx group (p= 0.50). Conclusion: Cardiac transplantation after LVAD implant can be performed with excellent results. Patients can be supported on the left ventricular assist device even for periods close to a year with good outcome after cardiac transplantation.

Original languageEnglish (US)
Pages (from-to)224-228
Number of pages5
JournalHeart Lung and Circulation
Volume23
Issue number3
DOIs
StatePublished - Mar 2014

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Heart-Assist Devices
Heart Transplantation
Therapeutics
Transplantation
Pulsatile Flow
Hospital Mortality
Length of Stay
Heart Failure
Transplants
Equipment and Supplies
Survival

Keywords

  • Cardiomyopathy
  • Circulatory assist devices
  • Heart failure
  • Surgical therapy
  • Transplantation (heart)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine

Cite this

Deo, S. V., Sung, K., Daly, R. C., Shah, I. K., Altarabsheh, S. E., Stulak, J. M., ... Park, S. J. (2014). Cardiac transplantation after bridged therapy with continuous flow left ventricular assist devices. Heart Lung and Circulation, 23(3), 224-228. https://doi.org/10.1016/j.hlc.2013.07.006

Cardiac transplantation after bridged therapy with continuous flow left ventricular assist devices. / Deo, Salil V.; Sung, Kiick; Daly, Richard C.; Shah, Ishan K.; Altarabsheh, Salah E.; Stulak, John M.; Joyce, Lyle D.; Boilson, Barry A.; Kushwaha, Sudhir S.; Park, Soon J.

In: Heart Lung and Circulation, Vol. 23, No. 3, 03.2014, p. 224-228.

Research output: Contribution to journalArticle

Deo, SV, Sung, K, Daly, RC, Shah, IK, Altarabsheh, SE, Stulak, JM, Joyce, LD, Boilson, BA, Kushwaha, SS & Park, SJ 2014, 'Cardiac transplantation after bridged therapy with continuous flow left ventricular assist devices', Heart Lung and Circulation, vol. 23, no. 3, pp. 224-228. https://doi.org/10.1016/j.hlc.2013.07.006
Deo, Salil V. ; Sung, Kiick ; Daly, Richard C. ; Shah, Ishan K. ; Altarabsheh, Salah E. ; Stulak, John M. ; Joyce, Lyle D. ; Boilson, Barry A. ; Kushwaha, Sudhir S. ; Park, Soon J. / Cardiac transplantation after bridged therapy with continuous flow left ventricular assist devices. In: Heart Lung and Circulation. 2014 ; Vol. 23, No. 3. pp. 224-228.
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abstract = "Introduction: Cardiac transplantation is an effective surgical therapy for end-stage heart failure. Patients (pts) may need to be bridged with a continuous flow left ventricular assist device (CF-LVAD) while on the transplant list as logistic factors like organ availability are unknown. Cardiac transplantation post-LVAD can be a surgically challenging procedure and outcome in these pts is perceived to be poorer based on experience with earlier generation pulsatile flow pumps. Data from a single institution comparing these pts with those undergoing direct transplantation in the present era of continuous flow device therapy are limited. Aim: Evaluate results of cardiac transplantation in pts bridged with a CF-LVAD (BTx) and compare outcomes with pts undergoing direct transplantation (Tx) in a single institution. Results: From June 2007 till January 2012, 106 pts underwent cardiac transplantation. Among these, 37 (35{\%}) pts (51. ±. 11 years; 85{\%} male) were bridged with a CF-LVAD (BTx), while 70 (65{\%}) comprised the Tx group (53. ±. 12 years; 72{\%} males). The median duration of LVAD support was 227 (153,327) days. During the period of LVAD support, 10/37 (27{\%}) pts were upgraded to status 1A and all were successfully transplanted. Median hospital stay in the BTx (14 days) was slightly longer than the Tx group (12 days) but not statistically significant (p= 0.21). In-hospital mortality in the BTx (5{\%}) and Tx (1{\%}) were comparable (p= 0.25). Estimated late survival in the BTx cohort was 94. ±. 7, 90. ±. 10 and 83. ±. 16{\%} at the end of one, two and three years, respectively which was comparable to 97. ±. 4{\%}, 93. ±. 6{\%} and 89. ±. 9{\%} for the Tx group (p= 0.50). Conclusion: Cardiac transplantation after LVAD implant can be performed with excellent results. Patients can be supported on the left ventricular assist device even for periods close to a year with good outcome after cardiac transplantation.",
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AU - Deo, Salil V.

AU - Sung, Kiick

AU - Daly, Richard C.

AU - Shah, Ishan K.

AU - Altarabsheh, Salah E.

AU - Stulak, John M.

AU - Joyce, Lyle D.

AU - Boilson, Barry A.

AU - Kushwaha, Sudhir S.

AU - Park, Soon J.

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N2 - Introduction: Cardiac transplantation is an effective surgical therapy for end-stage heart failure. Patients (pts) may need to be bridged with a continuous flow left ventricular assist device (CF-LVAD) while on the transplant list as logistic factors like organ availability are unknown. Cardiac transplantation post-LVAD can be a surgically challenging procedure and outcome in these pts is perceived to be poorer based on experience with earlier generation pulsatile flow pumps. Data from a single institution comparing these pts with those undergoing direct transplantation in the present era of continuous flow device therapy are limited. Aim: Evaluate results of cardiac transplantation in pts bridged with a CF-LVAD (BTx) and compare outcomes with pts undergoing direct transplantation (Tx) in a single institution. Results: From June 2007 till January 2012, 106 pts underwent cardiac transplantation. Among these, 37 (35%) pts (51. ±. 11 years; 85% male) were bridged with a CF-LVAD (BTx), while 70 (65%) comprised the Tx group (53. ±. 12 years; 72% males). The median duration of LVAD support was 227 (153,327) days. During the period of LVAD support, 10/37 (27%) pts were upgraded to status 1A and all were successfully transplanted. Median hospital stay in the BTx (14 days) was slightly longer than the Tx group (12 days) but not statistically significant (p= 0.21). In-hospital mortality in the BTx (5%) and Tx (1%) were comparable (p= 0.25). Estimated late survival in the BTx cohort was 94. ±. 7, 90. ±. 10 and 83. ±. 16% at the end of one, two and three years, respectively which was comparable to 97. ±. 4%, 93. ±. 6% and 89. ±. 9% for the Tx group (p= 0.50). Conclusion: Cardiac transplantation after LVAD implant can be performed with excellent results. Patients can be supported on the left ventricular assist device even for periods close to a year with good outcome after cardiac transplantation.

AB - Introduction: Cardiac transplantation is an effective surgical therapy for end-stage heart failure. Patients (pts) may need to be bridged with a continuous flow left ventricular assist device (CF-LVAD) while on the transplant list as logistic factors like organ availability are unknown. Cardiac transplantation post-LVAD can be a surgically challenging procedure and outcome in these pts is perceived to be poorer based on experience with earlier generation pulsatile flow pumps. Data from a single institution comparing these pts with those undergoing direct transplantation in the present era of continuous flow device therapy are limited. Aim: Evaluate results of cardiac transplantation in pts bridged with a CF-LVAD (BTx) and compare outcomes with pts undergoing direct transplantation (Tx) in a single institution. Results: From June 2007 till January 2012, 106 pts underwent cardiac transplantation. Among these, 37 (35%) pts (51. ±. 11 years; 85% male) were bridged with a CF-LVAD (BTx), while 70 (65%) comprised the Tx group (53. ±. 12 years; 72% males). The median duration of LVAD support was 227 (153,327) days. During the period of LVAD support, 10/37 (27%) pts were upgraded to status 1A and all were successfully transplanted. Median hospital stay in the BTx (14 days) was slightly longer than the Tx group (12 days) but not statistically significant (p= 0.21). In-hospital mortality in the BTx (5%) and Tx (1%) were comparable (p= 0.25). Estimated late survival in the BTx cohort was 94. ±. 7, 90. ±. 10 and 83. ±. 16% at the end of one, two and three years, respectively which was comparable to 97. ±. 4%, 93. ±. 6% and 89. ±. 9% for the Tx group (p= 0.50). Conclusion: Cardiac transplantation after LVAD implant can be performed with excellent results. Patients can be supported on the left ventricular assist device even for periods close to a year with good outcome after cardiac transplantation.

KW - Cardiomyopathy

KW - Circulatory assist devices

KW - Heart failure

KW - Surgical therapy

KW - Transplantation (heart)

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