Institutional Volume of Heart Transplantation with Left Ventricular Assist Device Explantation Influences Graft Survival

Abstract

<h3>Purpose</h3> There are increasing numbers of patients undergoing orthotopic heart transplantation (OHT) with left ventricular assist device (LVAD) explantation. We sought to assess the impact of institutional volume of LVAD explant-OHT on post-transplant graft survival. <h3>Methods and Materials</h3> This is a retrospective analysis of the Scientific Registry of Transplant Recipients for adult OHTs with long-term LVAD explantation. LVAD explant-OHT volume was characterized on the basis of the center's year-specific total OHT volume (OHTvol) and year-specific LVAD explant-OHT volume quartile (LVADvolQ). The effect of LVADvolQ on graft survival (death or re-transplantation) was analyzed. <h3>Results</h3> From 2004 to 2011, 2681 patients underwent OHT with LVAD explantation (740 HeartMate XVE, 1877 HeartMate II, 64 HeartWare). LVAD explant-OHT at centers falling in the lowest LVADvolQ (Q1) was associated with reduced post-transplant graft survival (p=0.022). After controlling for annualized OHTvol, which was not significant in this sample (HR=0.998, 95%CI=0.993-1.003, p=0.545), multivariate analysis confirmed a significantly (approximately 35%) increased risk of post-transplant graft failure among explant-OHT procedures occurring in centers in the lowest volume quartile (HR=1.352, 95%CI=1.012-1.798, p=0.038). <h3>Conclusions</h3> Graft survival is decreased when performed at centers falling in the lowest quartile of LVAD explant-OHT for a given year. This volume-survival relationship should be considered in the context of limited donor organ availability and rapidly proliferating LVAD centers. [figure 1]