Abstract
Successful bridging to transplantation (BTT) with ventricular assist devices (VAD) is an alternative to mitigate the effects of end-stage heart failure on organ function while awaiting a heart. The effects of long-term VAD BTT on patient outcomes following transplantation are poorly studied. A retrospective chart review identified 145 patients BTT with a VAD between November of 1996 and June of 2005 at the Cleveland Clinic. Patients were divided into two groups and outcomes were compared: group 1 was supported for <100 days (median=44 days) and group 2 was supported for > or =100 days (median=161 days). Patients in group 1 were less likely to be blood type O (33% vs 68%, p<0.0001). BTT <100 days trended towards independently predicting improved survival by multivariate proportional hazards analysis (risk ratio=0.75, 95% CI=0.52-1.08, p=0.12), largely due to reduced in-hospital mortality in this group (2% vs 11%, p=0.055); however, no significant difference with respect to long-term survival was observed by Kaplan-Meier analysis (p=0.14). Furthermore, causes of death differed between groups: group 1 more commonly died of coronary artery vasculopathy (26% vs 0%, p=0.022) and group 2 more commonly died of sepsis (60% vs 26%, p=0.026). Ultimately, 21% of all group 2 patients died from sepsis (compared to 7% of group 1 patients, p=0.018). This study suggests that prolonged BTT with a VAD is a viable treatment strategy but may lead to significantly more post-transplant deaths from sepsis and higher in-hospital mortality. These data may inform management of this high-risk patient population.
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