Abstract 3378: Post-transplant Survival is Not Diminished in Heart Transplant Recipients Bridged With Implantable Left Ventricular Assist Devices
Background. The purpose of this study was to compare post-transplantation morbidity and mortality in orthotopic heart transplant (OHT) recipients bridged-to-transplant (BTT) with a left ventricular assist device (LVAD) with non-bridged (NB) recipients. To account for potential differences across device types, BTT recipients were stratified by VAD type: extra-corporeal (EXTRA), para-corporeal (PARA), and intra-corporeal (INTRA).
Methods. UNOS provided de-identified patient-level data. The study population included 10,668 orthotopic heart transplant (OHT) recipients aged ≥18 years old and transplanted between January 1, 2001 and December 31, 2006. Follow-up data was provided through August 3, 2008 with a mean follow-up time of 3.17±2.15 (range: 0–8.11) years. The primary outcome was actuarial post-transplant graft survival. Multivariable Cox proportional hazards regression (backward, p<0.15) was used to determine the relationship between groups and overall graft survival.
Results. In multivariate Cox regression analysis, when compared with the NB group, risk-adjusted <90-day graft survival was diminished among the EXTRA (HR=3.54, 2.28–5.51). For 1–5 years, risk-adjusted graft survival in the INTRA group (0.389, 0.205–0.738, p=0.004) was better than the NB group.
Conclusion. The use of implantable left ventricular assist devices as bridge-to-transplantation, including both intra and para-corporeal devices, is not associated with diminished post-transplant survival. However, 90-day was diminished in recipients bridged with extra-corporeal devices.