(489) - Does a Crumbling Bridging Strategy Put Patient at Risk for Cardiac Transplantation?

Abstract

Outcome after cardiac transplantation is significantly influenced by pre-operative condition of recipients. Mechanical ventricular assist device therapy (VAD) has revolutionized bridging strategies for transplantation. However, contradictive data exist, if VAD patients deteriorate and high urgent transplantation becomes necessary. The aim of this analysis was to examine outcome of high urgent VAD patients. We retrospectively evaluated adult (≥16a) patients undergoing cardiac transplantation at out institution between January 2006 and December 2013. Patients were divided into 4 groups (VAD, VAD-high urgent, high urgent and non-high urgent non-VAD). Primary endpoints were primary graft dysfunction (PGD), 30-day and one year survival. Survival was calculated by Kaplan-Meier analysis and differences were tested by log-rank test. 282 patients (68(24%) female, 214 male (76%) male) older than 16 years underwent cardiac transplantation at our institution between January 2006 and December 2013. Median age was 56±13 years. 65 (23%) patients underwent left ventricular assist device implantation (LVAD) prior cardiac transplantation. A small group of 6 (2.1%) patients required extracorporeal membrane oxygenation (ECMO) support prior to cardiac transplantation. 86 (30.4%) patients had high urgency (HU) status at the time of transplantation. In the HU status patients group non-LVAD vs VAD vs ECMO were 58(20.5%) vs. 22(7.8%) vs. 6(2.1%). PGD rate was not different between the four groups ( HU: 12%, HU-VAD: 17%, VAD: 12%, other: 13%). Overall thirty day and one year mortality was 4% and 13%. HU non-LVAD patients (n=64) vs HU LVAD patients (n=22) had a thirty day and one year mortality of 5% vs. 16% and 9% vs. 18% respectively. (n.s.). Patients who were not on HU status had a 30 day and one year mortality rate of 6%and 16% (non LVAD patients) vs. 5% and 10% (VAD patients) (n.s.). HU patients seem to have similar early and 1-year survival rates compared to non-HU patients. Numerically VAD-HU patients have a higher mortality compared to non-VAD patients. Future analysis are needed to select those deteriorating VAD patients where HU is associated with good outcome.