Abstract 2887: Impact of Mechanical Support and Device Type on Outcomes Following Cardiac Transplantation
Background - Left ventricular assist devices (LVADs) are increasingly used as a bridge to transplant. Continuous-flow (CF) devices have several advantages over pulsatile flow (PF) devices including smaller size, mechanical simplicity and durability. We hypothesized that patients bridged with CF devices would have improved outcomes compared to those bridged with PF devices and similar outcomes to those proceeding directly to transplant.
Methods -The United Network of Organ Sharing (UNOS) provided de-identified patient-level data for all patients who underwent heart transplantation in the US between 7/1/2004 and 9/6/2006. All adult patients who were either status IA or IB were included. Post-transplantation mortality and morbidity among recipients bridged with PF or CF devices and those not bridged with an LVAD are compared.
Results - 2912 patients were included in the analysis (688 PF, 147 CF, 2077 noVAD). Median follow-up was 116 days (0–783 days). Baseline characteristics differed between groups (Table 1⇓). Actuarial survival was not different between PF and CF. When compared to noVAD, CF and PF each had a decreased survival. In multivariate analysis, PF, CF, or noVAD was not a predictor of survival. Freedom from rejection was not different between groups. Post-transplant morbidity was not different between PF and CF. A higher incidence of infection as well as non-cardiac and cardiac reoperation occurred in CF when compared to noVAD. PF compared similarly to noVAD but, in addition, had a higher incidence of stroke.
Conclusions - Patients bridged to transplant with CF or PF LVADs had similar outcomes when compared to each other. However, both CF and PF had inferior outcomes when compared to noVAD.