One hundred days or more bridged on a ventricular assist device and effects on outcomes following heart transplantation☆

Abstract

This study suggests that prolonged BTT with a VAD is a viable treatment strategy but may lead to significantly more post-transplant deaths from sepsis and higher in-hospital mortality. These data may inform management of this high-risk patient population.

Optimal timing for heart transplantation in patients bridged with left ventricular assist devices: Is timing of the essence?

“…The question of optimal BTT duration has been previously examined. Most recently, Grimm and colleagues 11 investigated 1332 patients BTT with an LVAD using United 13,14,18,19 Our study is complementary to these investigations but provides new insights. First, we have 6 years of recent data (to 2014).…”

Duration of Left Ventricular Assist Device Support Does Not Impact Survival After US Heart Transplantation

“…The influence of device duration on post-OHT survival has been examined by other groups, but their findings are limited primarily by a lack of homogeneity and small sample size [10][11][12]. In a multicenter study of 250 HeartMate II patients, John and associates analyzed survival outcomes stratified by duration of support and found that there was no difference among patients managed for less [10].…”

“…Extracorporeal devices were included in the analysis and, hence, this reported difference might reflect disparities in patient acuity and might not be applicable to modern BTT cohorts. In a single institutional series, Robertson and colleagues [12] stratified 145 patients based on LVAD durations of less than 100 days or 100 days or more, with the former having a statistically insignificant but clinically relevant 10% survival advantage [12]. The functional benefit associated with LVAD therapy has been established [15][16][17], but its relationship to device duration in a BTT cohort was previously unknown.…”

“…Although several series have explored the topic, their findings and recommendations are largely conflicting, principally because of their inconsistent definitions of "prolonged" support and overall small sample sizes [10][11][12]. Accordingly, we sought to determine whether LVAD duration influences outcomes after OHT in a large, modern BTT cohort.…”

Postcardiac transplant survival in the current era in patients receiving continuous-flow left ventricular assist devices

“…This is an important question because conflicting reports have been published on the effect of LVADs on post-transplant survival. [7][8][9][10][11] The objective of the present study was to evaluate the post-transplant survival of patients supported by continuous-flow devices at a single center.…”