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  • Outcome of cardiac transplantation in patients requiring prolonged continuous-flow left ventricular assist device support.

Outcome of cardiac transplantation in patients requiring prolonged continuous-flow left ventricular assist device support.

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (2014-12-03)
Koji Takeda, Hiroo Takayama, Bindu Kalesan, Nir Uriel, Paolo C Colombo, Ulrich P Jorde, Melana Yuzefpolskaya, Donna M Mancini, Yoshifumi Naka
ABSTRACT

This study assessed the early and late outcomes after cardiac transplantation in patients receiving long-term continuous-flow left ventricular assist device (CF-LVAD) support. Between April 2004 and September 2013, 192 patients underwent HeartMate II (Thoratec, Pleasanton, CA) CF-LVAD placement as a bridge to transplant at our center. Of these, 122 (63%) successfully bridged patients were retrospectively reviewed. Patients were stratified into 2 groups according to their waiting time with CF-LVAD support of <1 year or ≥1 year. The study cohort was a mean age of 54 ± 13 years, 79% were male, and 35% had an ischemic etiology. The mean duration of CF-LVAD support before transplantation was 296 days (range, 27-1,413 days). The overall 30-day mortality was 4.1%. Overall post-transplant survival was 88%, 84%, 78% at 1, 3, and 5 years, respectively. The 32 patients (26%) with ≥1 year of CF-LVAD support (mean, 635 days) were more likely to have blood type O, a larger body size, and to have been readmitted due to recurrent heart failure and device failure requiring exchange than those with <1 year of CF-LVAD support. Patients who required prolonged support time also had worse in-hospital mortality (16% vs 6.7%, p = 0.12) and significantly lower survival at 3 years after transplantation (68% vs 88%, p = 0.049). The overall short-term and long-term cardiac transplant outcomes of patients supported with CF-LVAD are satisfactory. However, patients who require prolonged CF-LVAD support may have diminished post-transplant survival due to adverse events occurring during device support.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Azathioprine, ≥98%
Azathioprine, European Pharmacopoeia (EP) Reference Standard
Supelco
Azathioprine, Pharmaceutical Secondary Standard; Certified Reference Material
USP
Azathioprine, United States Pharmacopeia (USP) Reference Standard
Sigma-Aldrich
6α-Methylprednisolone, ≥98%
Methylprednisolone, European Pharmacopoeia (EP) Reference Standard
USP
Methylprednisolone, United States Pharmacopeia (USP) Reference Standard