The Interaction of Amiodarone and Continuous-flow Left Ventricular Assist Device Use in Risk of Severe Primary Graft Dysfunction Following Heart Transplantation

Chinnadurai, T.; Patel, Snehal R.; Saeed, Omar; Hanif, Waqas; Rivas‐Lasarte, Mercedes; Farooq, Muhammad; Castillo, Carolyne; Taveras, M.; Fauvel, D.; Shin, J.; Sims, Daniel B.; Murthy, Sandhya; Vukelic, S.; Chavez, Patricia; Forest, S.; Goldstein, Daniel J.; Jorde, Ulrich P.

doi:10.1097/txd.0000000000001281

Cited by 4 publications

(2 citation statements)

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“…Patients bridged to HT with a durable LVAD have an increased risk for PGD and decreased post-HT survival. [1][2][3][4] These associations are likely driven by multiple factors, including the higher level of operative complexity required for HT surgery in patients with LVAD and resultant prolonged ischemic times. 27 The 2018 United Network for Organ Sharing allocation policy changes, in which patients with LVAD were deprioritized, have led to a subsequent increase in waitlist times, and a further decline in post-HT survival, for patients with LVAD.…”

Section: Discussionmentioning

confidence: 99%

“…While LVAD use as a bridge to HT is necessary due to organ scarcity, it is also associated with a significant increase in primary graft dysfunction (PGD) after HT and with decreased posttransplantation survival compared with patients not requiring LVAD as the bridge to HT. 1–4 Therefore, identifying strategies to mitigate PGD and optimize posttransplant outcomes in this vulnerable population of HT recipients is critical. As HT surgery in patients with LVAD often produces longer ischemic times due to increased operative complexity, innovations in donor heart preservation methods may yield improved postoperative outcomes among these patients.…”

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confidence: 99%

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Early Outcomes in Patients With LVAD Undergoing Heart Transplant via Use of the SherpaPak Cardiac Transport System

Lerman,

Patel,

Casalinova

et al. 2024

Circ: Heart Failure

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BACKGROUND: Heart transplant (HT) in recipients with left ventricular assist devices (LVADs) is associated with poor early post-HT outcomes, including primary graft dysfunction (PGD). As complicated heart explants in recipients with LVADs may produce longer ischemic times, innovations in donor heart preservation may yield improved post-HT outcomes. The SherpaPak Cardiac Transport System is an organ preservation technology that maintains donor heart temperatures between 4 °C and 8 °C, which may minimize ischemic and cold-induced graft injuries. This analysis sought to identify whether the use of SherpaPak versus traditional cold storage was associated with differential outcomes among patients with durable LVAD undergoing HT. METHODS: Global Utilization and Registry Database for Improved Heart Preservation-Heart (NCT04141605) is a multicenter registry assessing post-HT outcomes comparing 2 methods of donor heart preservation: SherpaPak versus traditional cold storage. A retrospective review of all patients with durable LVAD who underwent HT was performed. Outcomes assessed included rates of PGD, post-HT mechanical circulatory support use, and 30-day and 1-year survival. RESULTS: SherpaPak (n=149) and traditional cold storage (n=178) patients had similar baseline characteristics. SherpaPak use was associated with reduced PGD (adjusted odds ratio, 0.56 [95% CI, 0.32–0.99]; P =0.045) and severe PGD (adjusted odds ratio, 0.31 [95% CI, 0.13–0.75]; P =0.009), despite an increased total ischemic time in the SherpaPak group. Propensity matched analysis also noted a trend toward reduced intensive care unit (SherpaPak 7.5±6.4 days versus traditional cold storage 11.3±18.8 days; P =0.09) and hospital (SherpaPak 20.5±11.9 days versus traditional cold storage 28.7±37.0 days; P =0.06) lengths of stay. The 30-day and 1-year survival was similar between groups. CONCLUSIONS: SherpaPak use was associated with improved early post-HT outcomes among patients with LVAD undergoing HT. This innovation in preservation technology may be an option for HT candidates at increased risk for PGD. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04141605.

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