Continuous-flow Left Ventricular Device Support Research Articles

Primary graft dysfunction (PGD) is the most catastrophic complication after cardiac transplantation. However, little is known about PGD in patients who are bridged with contemporary continuous-flow left ventricular assist devices (LVAD). Between May 2004 and December 2013, 145 patients underwent cardiac transplantation after continuous-flow LVAD support as a bridge to transplant at our center. Degree of PGD was classified into mild, moderate, and severe according to recently published the International Society for Heart and Lung Transplantation consensus statement. The mean age of the study cohort was 54 ± 14 years, 81% were male, and 35% were ischemic etiology. The median duration of LVAD support before transplantation was 205 days. Thirty-six patients (25%) developed PGD (mild 4, moderate 22, severe 10) within 24 hours after transplantation. For severe PGD, biventricular assist device was used in all patients. Mean left ventricular ejection fraction immediately after transplantation was 57 ± 5.6% in non-PGD, 45 ± 9.5% in mild/moderate PGD, and 13 ± 10% in severe PGD group (p<0.0001). In-hospital mortality in non-PGD, mild/moderate PGD, and severe PGD were 5.5%, 7.7%, and 60%, respectively (p=0.002). The 1-year post-transplant survival in non-PGD, mild/moderate PGD, and severe PGD were 91%, 92%, and 25%, respectively (p<0.0001). PGD after bridge with continuous-flow LVAD is common. Patients who developed severe PGD had a dismal outcome. A multi-center study including large cohort is warranted to extend our findings.

Read full abstract