Mechanical circulatory support and heart transplantation: Donor and recipient factors influencing graft survival

Simon Maltais, Nikhil P. Jaik, Irene D. Feurer, Mark A. Wigger, Thomas G. Disalvo, Kelly H. Schlendorf, Rashid M. Ahmad, Daniel J. Lenihan, John M. Stulak, Mary E. Keebler

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Background: Mechanical circulatory support is an accepted strategy to bridge patients to heart transplantation (HTx). Among mechanical circulatory support patients who go on to HTx, factors associated with improved graft survival have not been fully elucidated. Methods: Using the Scientific Registry for Transplant Recipients, we identified adults who were treated with a left ventricular assist device (LVAD) or total artificial heart (TAH) before HTx. Kaplan-Meier and multivariate Cox regression models were used to identify patient, donor, and device characteristics associated with graft survival. Results: Between January 1997 and February 2012, 2,785 adults underwent HTx. Before HTx, 2,674 patients were treated with a LVAD (HeartMate XVE, 724; HeartMate II, 1,882; HeartWare, 68), and 111 were treated with a TAH. Follow-up averaged 25 ± 24 months. Gender mismatch occurred in 23%. Graft survival did not differ between LVAD groups (all p > 0.168), but TAH was associated with reduced graft survival compared with LVADs (p < 0.001). After controlling for device type (LVAD vs TAH), lower recipient pulmonary vascular resistance, shorter ischemic time, younger donor age, donor-to-recipient gender match, and higher donor-to-recipient body mass index ratio were independent predictors of longer graft survival (all p < 0.05). Conclusions: TAH was associated with reduced graft survival after transplant, and survival did not differ between the LVAD device groups. Additional variables that were independently associated with graft survival were donor age, recipient peripheral vascular resistance, ischemic time, gender match, and donor-to-recipient body mass index ratio. Recognition of these factors may inform decisions regarding device support and donor suitability.

Original languageEnglish (US)
Pages (from-to)1252-1258
Number of pages7
JournalAnnals of Thoracic Surgery
Volume96
Issue number4
DOIs
StatePublished - Oct 2013

ASJC Scopus subject areas

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

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    Maltais, S., Jaik, N. P., Feurer, I. D., Wigger, M. A., Disalvo, T. G., Schlendorf, K. H., Ahmad, R. M., Lenihan, D. J., Stulak, J. M., & Keebler, M. E. (2013). Mechanical circulatory support and heart transplantation: Donor and recipient factors influencing graft survival. Annals of Thoracic Surgery, 96(4), 1252-1258. https://doi.org/10.1016/j.athoracsur.2013.05.043