Impact of Left-Ventricular Assist Device–Related Complications on Posttransplant Graft Survival

Abstract

This study describes the impact of continuous-flow left-ventricular-assist device (CF-LVAD)-related complications on postoperative outcomes. The United Network for Organ Sharing (UNOS) heart transplant follow-up data from 2005 to 2015 were obtained. CF-LVAD patients who were bridged to transplant were studied. Device-related complications (DRCs) at patient's last follow-up before transplantation were reported in 5 categories: device thrombosis (B1), infection (B2), device malfunction (B3), life-threatening arrhythmias (B4), and others (B5). Multivariable Cox regression models were used to evaluate the association of each category of complications and number of complications with postoperative graft survival. Of 3,877 patients analyzed, incidence of DRCs was as following: 374 (9.65%) for thrombosis (B1), 869 (22.41%) for device-related infection (B2), 400 (10.32%) for device malfunction (B3), 135 (3.48%) for life-threatening arrhythmias (B4), and 510 (13.15%) for others (B5). A total of 2,018 (52.05%) patients did not have any DRC at last follow-up; 1,482 (38.23%) patients had 1 DRC and 377 (9.72%) patients had 2 or more DRCs. Mean time from last preoperative follow-up to transplant in patients with 0, 1, and 2 or more DRCs was 93, 18, and 11 days, respectively. Multivariate analysis showed that none of the complications (from B1 to B5) were independent risk factors for poor graft survival after cardiac transplantation. Independent predictors of postoperative graft failure were increasing donor age, inpatient status, increasing body mass index, poor functional status, ventilator dependence, and extracorporeal membrane oxygenation at the time of transplant. DRCs are common among advanced heart failure patients bridged to transplant with CF-LVADs. Contrary to popular belief, DRCs are not associated with poor postoperative graft survival.