Introduction
Cardiac transplantation is an effective surgical therapy for end-stage heart failure.
Patients (pts) may need to be bridged with a continuous flow left ventricular assist
device (CF-LVAD) while on the transplant list as logistic factors like organ availability
are unknown. Cardiac transplantation post-LVAD can be a surgically challenging procedure
and outcome in these pts is perceived to be poorer based on experience with earlier
generation pulsatile flow pumps. Data from a single institution comparing these pts
with those undergoing direct transplantation in the present era of continuous flow
device therapy are limited.
Aim
Evaluate results of cardiac transplantation in pts bridged with a CF-LVAD (BTx) and
compare outcomes with pts undergoing direct transplantation (Tx) in a single institution.
Results
From June 2007 till January 2012, 106 pts underwent cardiac transplantation. Among
these, 37 (35%) pts (51 ± 11 years; 85% male) were bridged with a CF-LVAD (BTx), while 70 (65%) comprised the
Tx group (53 ± 12 years; 72% males). The median duration of LVAD support was 227 (153,327) days.
During the period of LVAD support, 10/37 (27%) pts were upgraded to status 1A and
all were successfully transplanted. Median hospital stay in the BTx (14 days) was
slightly longer than the Tx group (12 days) but not statistically significant (p = 0.21). In-hospital mortality in the BTx (5%) and Tx (1%) were comparable (p = 0.25). Estimated late survival in the BTx cohort was 94 ± 7, 90 ± 10 and 83 ± 16% at the end of one, two and three years, respectively which was comparable to 97 ± 4%, 93 ± 6% and 89 ± 9% for the Tx group (p = 0.50).
Conclusion
Cardiac transplantation after LVAD implant can be performed with excellent results.
Patients can be supported on the left ventricular assist device even for periods close
to a year with good outcome after cardiac transplantation.
Keywords
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Article info
Publication history
Published online: August 15, 2013
Accepted:
July 10,
2013
Received in revised form:
July 8,
2013
Received:
April 20,
2013
Identification
Copyright
© 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
