Abstract 18438: Long Term Left Ventricular Assist Device as Bridge to Heart Transplantation — is it Really a Bridge?
Background: Left ventricular assist devices (LVAD) are increasingly used as bridge to transplant (BTT) for patients with advanced congestive heart failure (CHF). After LVAD implantation, patients' UNOS status is permanently updated to 1B. Patients may also be upgraded to 1A for a total of 30 days at the clinicians' discretion and/or permanently if a device complication occurs. The aim of this study was to evaluate the UNOS status of patients on LVAD support at the time of transplantation and to determine the reasons for status changes.
Methods: A retrospective chart review was performed of all patients transplanted between 1/2001–2/2010 at our transplant center.
Results: 789 heart transplantations were performed and 224 patients received a long term BTT during the observation period. Of 224 BTT patients, 180 (80.4%) were males, mean age was 51.9 +/−12.6 years. 166 (74.1%) BTT patients were transplanted. Mean time from LVAD implantation to transplant was 166.6 +/−164.1 days. Only 44 patients were transplanted as UNOS 1B, while 122 were transplanted as UNOS 1A. Of these 122, 70 patients were transplanted during their 30 days 1A grace period and 52 patients after upgrading to UNOS 1A due to device complication or malfunction. Of the 58 patients who were not transplanted, 25 (11.2% of all BTT) are still listed, while 33 (14.7% of all BTT) patients were de-listed due to mortality or advanced co-morbidity (figure). Blood type O patients represented only 40.0% of 1B HTX recipients while they represent 60.3% 1A HTX recipients.
Conclusion: After utilizing the initial 30 day 1A grace period, many LVAD BTT patients (particularly those with blood type 0) are unlikely to be transplanted in our procurement region unless they experience a device complication justifying upgrade of UNOS status to 1A. As device technology improves and complication rates fall, many of these patients will have de facto destination therapy.
- © 2010 by American Heart Association, Inc.