Does successful bridging with the implantable left ventricular assist device affect cardiac transplantation outcome?

Abstract

Left ventricular assist device support intensified the donor shortage by including recipients who otherwise would not have survived to transplantation. Bridging affected transplant demographics, favoring patients who are larger, have ischemic cardiomyopathy, have had multiple blood transfusions and complex cardiac operations, and are HLA sensitized. Successfully bridged patients wait longer for a transplant than do UNOS status I patients without such a bridge, but they have similar posttransplantation hospital stay, operative mortality, and survival to those of patients not requiring left ventricular assist device support.

Cost–effectiveness of left ventricular-assist devices in end-stage heart failure

“…80 The other six studies used a cohort design with nonrandomised allocation of patients to the groups included in the studies, providing the opportunity for allocation bias. The risk of selection bias and confounding was particularly high in five of the studies, [81][82][83]85,86 a consequence of either the poor reporting of patient characteristics or the imbalance in the characteristics of the different groups. Although the CCT comparing the HeartMate and Novacor LVADs had a high risk of selection bias owing to the limited information provided on patient selection, there appeared to be no major differences between the groups limiting the possible effects of confounding.…”

“…Seven of the studies of first-generation LVADs investigated the use of the HeartMate IP and/or VE devices, with one CCT, 80 three retrospective cohort analytical studies [81][82][83] and three cohort studies, either before and after 84 or compared with a historical control group. 85,86 Of the six studies comparing the use of the HeartMate LVADs with an alternative intervention, one study compared the HeartMate VE LVAD with the Novacor N100 LVAD, 80 two studies used inotropic agents as the comparator 82,83 and three studies did not define the medical care given to the control group.…”

“…85,86 Of the six studies comparing the use of the HeartMate LVADs with an alternative intervention, one study compared the HeartMate VE LVAD with the Novacor N100 LVAD, 80 two studies used inotropic agents as the comparator 82,83 and three studies did not define the medical care given to the control group. 81,85,86 The other studies of first-generation LVADs were a cohort analytic study comparing the short-and long-term use of the Novacor LVAD, 87 a case series of the Toyobo LVAD, 88 and two case reports of the Thoratec device. 89,90 Of the five studies of second-generation LVADs, three were before and after cohort studies of the MicroMed DeBakey LVAD [91][92][93] and the other two were case series of the Jarvik 2000 LVAD, one of which was a multicentre case series, with individual centres reporting their patient data at different periods of follow-up for different subgroups.…”

“…Details of the reliability and validity of the methods of data collection used were reported in only one study, 84 which focused on assessing QoL. The other six studies [80][81][82][83]85,86 provided very limited information on their methods of data collection and as a consequence were rated as being methodologically weak. However, the studies focused on survival, organ function and functional capacity as the main outcomes, which tend to be more objective measures and less prone to bias.…”

“…Three studies were not assessed on the criteria for withdrawals as they were considered not applicable for retrospective studies. [81][82][83] In addition, none of the studies either reported results using an intention-to-treat analysis 82,83,85,86 or it was unclear how results were reported, 80,81 providing the possibility for the studies to be affected by attrition bias. Intention-to-treat analysis was considered not applicable for the study by Grady and colleagues.…”