National Trends and Outcomes of Patients Bridged to Transplant With Continuous Flow Left Ventricular Assist Devices

Fugar, Setri; Okoh, Alexis K.; Eshun, Derek; Yirerong, Juliet; Appiah, Lambert; Mbachi, Chimezie; Legge, T.; Camacho, M.; Russo, Mark J.

doi:10.1016/j.transproceed.2019.01.036

Cited by 5 publications

(5 citation statements)

References 12 publications

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“…While it is reassuring that post-transplant survival does not seem to be affected by pre-transplant device-related complications, the finding from Bakir et al that these complications decrease the probability of transplantation are of obvious concern. Fugar et al have reported similar findings from an analysis of 7070 continuous-flow LVAD BTT patients identified in the UNOS database from 2008 to 2015 [10]. They found that the development of 1 device-related complication significantly increased the risk of death or delisting, however, the development of 2 or more device-related complications almost doubled this risk.…”

Section: Competing Risks Of Durable Lvad Support Before and After Hea...mentioning

confidence: 62%

Durable mechanical circulatory support as bridge to heart transplantation

Badiwala

Dvirnik²,

Rao³

2022

Current Opinion in Organ Transplantation

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Purpose of reviewDurable mechanical circulatory support (MCS) technology has changed over time as devices have evolved from pulsatile to continuous flow support. In this review, we discuss recent data and substantial changes to current practice as it pertains to the subject of current era durable left ventricular assist devices (LVADs) as a bridge to heart transplantation.Recent findingsThe results of heart transplantation in patients bridged with durable LVAD support are satisfactory even after prolonged duration of support. Reports of recent experience with LVAD related infection suggest that this complication has limited impact on post-transplant outcomes. Important sex-related disparities continue to exist following durable LVAD implantation. Recent changes in the United Network for Organ Sharing donor heart allocation policy have resulted in a drastic decline in the use of durable LVAD support for Bridge to Transplant in the United States.SummaryDurable MCS in the form of LVAD as a BTT strategy continues to evolve over time. Optimization of its role in the treatment of end-stage heart failure, particularly in females will need to be the focus of future research.

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Section: Competing Risks Of Durable Lvad Support Before and After Hea...mentioning

confidence: 62%

Durable mechanical circulatory support as bridge to heart transplantation

Badiwala

Dvirnik²,

Rao³

2022

Current Opinion in Organ Transplantation

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“…In this case, the use of biventricular temporary mechanical support in the setting of LVAD complications put our patient at equivalent risk to others at the most urgent wait-list status and allowed us to obtain status 1 listing approval from the United Network for Organ Sharing Review Board. However, once a complication occurs, the risk for death or delisting markedly increases ( 2 ). Adverse events after continuous-flow LVAD placement include bleeding, stroke, infection, RV failure, AI, and device malfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Left ventricular assist devices (LVADs) provide durable mechanical circulatory support (MCS) as destination therapy or bridge to heart transplantation (BTT). Despite significant improvements in survival, functional capacity, and quality of life, LVAD therapy is limited by potential long-term medical and surgical complications ( 1 , 2 ). We report a patient with an LVAD who presented with cardiogenic shock and underwent successful BTT with biventricular Impella (Abiomed, Danvers, Massachusetts) support.…”

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confidence: 99%

Crossing the Bridge to Heart Transplantation

et al. 2020

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“…End-stage heart failure continues to be a significant health burden in the United States, with transplantation the gold-standard for treatment. 1,2 The introduction of left ventricular assist devices (LVADs) as durable mechanical circulatory support has drastically changed how these patients are managed. 1 The safety of LVADs as bridge-to-transplant therapy has increased significantly since their introduction in the field, leading to their widespread use.…”

mentioning

confidence: 99%

“…7,8 Due to recent, rapid advances in LVAD technology, contemporary LVAD research has largely focused on morbidity and mortality associated with device implantation and the effect that bridging with durable LVADs has had on short-term (<1 year) posttransplant outcomes. 2,[9][10][11][12] Prior studies have found a slight early survival advantage among patients who were not bridged with an LVAD, although it is more often systemic complications and not specifically device-related complications that are associated with worse posttransplant survival. 13,14 Few studies have examined the impact of pretransplant MCS devices on mortality beyond 1 year, though those that have investigated the question have found that posttransplantation outcomes are not greatly affected by pretransplant device implantation and that device complications do not significantly impact posttransplant survival.…”

mentioning

confidence: 99%

Posttransplant Long-Term Outcomes for Patients with Ventricular Assist Devices on the Heart Transplant Waitlist

Whitbread

Etchill²,

Giuliano³

et al. 2021

ASAIO Journal

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Ventricular assist devices (LVADs) are commonly used in end-stage heart failure for mechanical circulatory support as a bridge to heart transplantation. However, LVADs' long-term effects on posttransplant survival are unknown. We sought to compare long-term mortality after transplantation for patients with and without LVADs. Using the Organ Procurement and Transplantation Network database, we investigated LVADs' impact on long-term (3 month, 1 year, 2 years, 5 years, and 8 years) posttransplant mortality risk for all heart transplant recipients between 2010 and 2019. Time-to-event regression analysis quantified mortality risk by LVAD status in both unconditional and conditional survival analyses. Of 20,113 transplant recipients, 8,999 (45%) had a LVAD while on the waitlist. Among those who died after transplantation, patients with LVADs on average died sooner (1.8 years) than patients without LVADs (3.0 years; p < 0.01). On multivariable analysis, patients with LVADs had a 44% higher mortality risk within the first 3 months posttransplant (HR = 1.44, p = 0.03). There was no significant difference in mortality risk between patients who did and did not have pretransplant LVADs after 1, 2, and 5 years of posttransplant conditional survival. While LVAD patients have a survival disadvantage in the first year posttransplant, conditional survival analysis demonstrated no difference in mortality risk between patients with and without LVADs beyond 1 year of follow up. Of the patients who died posttransplant, patients with LVADs on average died sooner than patients without LVADs. ASAIO

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National Trends and Outcomes of Patients Bridged to Transplant With Continuous Flow Left Ventricular Assist Devices

Cited by 5 publications

References 12 publications

Durable mechanical circulatory support as bridge to heart transplantation

Durable mechanical circulatory support as bridge to heart transplantation

Crossing the Bridge to Heart Transplantation

Posttransplant Long-Term Outcomes for Patients with Ventricular Assist Devices on the Heart Transplant Waitlist

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