Left Ventricular Assist Devices in Patients with Transposition of the Great Arteries: Survival and Adverse Events

Abstract

Background Transposition of the great arteries (TGA) is a common congenital anomaly in which the aorta arises from the morphological systemic right ventricle (SRV), and the pulmonary artery arises from the morphologic left ventricle. With surgical and medical advancements, TGA patients are living longer and as a result failure of the SRV is a common cause of morbidity and mortality. Orthotopic heart transplantation (OHT) has been shown to be a successful strategy for TGA patients that progress to end stage heart failure. Candidacy for OHT is often jeopardized due to allosensitization, pulmonary hypertension, or hemodynamic instability. Little is known about long term outcomes of Left Ventricular Assist Devices (LVAD) in patients with TGA. In this study we present long term outcomes of TGA patients with LVADs. Methods This was a single center retrospective analysis of 309 consecutive patients who underwent LVAD placement from May 2008 to February 2020. Our primary outcome of interest was Post LVAD survival. Secondary outcomes of interest were hospitalizations for gastrointestinal (GI) bleeds, driveline infections (DLI), pump thromboses, acute heart failure, and right ventricular (RV) failure were outcomes of interest. The Cox proportional hazard model was used to estimate the association of TGA and AE-related hospital admissions. The cumulative incidence competing risk method was used for survival analysis. Results From May 2008 - February 2020, 10 patients with TGA underwent LVAD placement. Mean follow up was 1.3 years. TGA patients were younger, Caucasian and more likely to be male. TGA patients had similar likelihood of LVAD mortality (HR 1.35, CI 0.70-2.61, p= 0.37), RV failure (1.8, CI 0.35-10.16, p= 0.46), GI bleeding (OR 1.76, CI .33-9.47, p= 0.51), Heart failure hospitalizations (OR 1.12, CI 0.13-9.84, p= 0.55), DLI (OR 0.63, CI 0.07-5.40, p=0.64) and VAD thrombosis (OR 1.23, CI 0.28-6.68, p=0.69) as non TGA patients. Conclusions In this analysis of TGA patients with end stage heart failure, we report that TGA patients have similar outcomes to non-TGA patients post LVAD. LVAD should be considered a durable option for TGA patients who progress to end stage HF. Further studies with a larger population is warranted to further assess LVAD associated adverse events in this patient population.