Abstract 276: The Impact of Ventricular Assist Devices on Blood Product Utilization for Cardiac Transplantation
Purpose: Ventricular assist device (VAD) support as a bridge to cardiac transplantation has introduced device-related complications to cardiac surgery. Specifically, therapeutic anticoagulation in newer generational devices is a primary challenge. The purpose of this study was to examine whether blood product utilization and mortality significantly differ for VAD patients compared to non-VAD (NVAD) patients following cardiac transplantation.
Methods: From 2004-2010, 76 patients underwent cardiac transplantation at a single institution. Patients were stratified by VAD presence at transplantation: VAD patients (n=40, age: 50.8±11.0 years) vs. NVAD patients (n=36, age: 48.6±12.3 years). The primary outcomes of interest were blood product transfusion requirements and 30-day mortality.
Results: Preoperative patient characteristics were similar for VAD and NVAD patients. NVAD patients presented with higher median preoperative creatinine levels compared to VAD patients (1.3 [1.10-1.58] vs. 1.1 [0.93-1.38], P=0.01). In addition, more NVAD patients required preoperative ACE-inhibitor therapy (P<0.001). Preoperative warfarin therapy was expectedly more common among VAD patients (P<0.001). Importantly, VAD patients accrued higher intra-operative transfusion of all blood products (all P<0.001) as well as higher postoperative packed red blood cell transfusions (P=0.04) compared to NVAD patients (Table). 30-day mortality was not significantly different between groups (7.5% vs. 8.3%, P>0.99).
Conclusions: VAD support and the inherent requirement for anti-coagulation have significantly increased blood product utilization for cardiac transplantation. Despite these requirements, mortality rates remain similar to that of NVAD patients undergoing transplantation. Further study to define an optimal preoperative anticoagulation strategy for VAD patients may help to decrease the future resuscitative burden for cardiac transplantation.
- © 2011 by American Heart Association, Inc.