Abstract 17653: Net Survival Benefit of Heart Transplantation Following Mechanical Circulatory Support in Patients Bridged to Transplant in the Modern Era
OBJECTIVE: Mechanical circulatory support (MCS) outcomes approach those of orthotopic heart transplant (OHT). We assessed the net transplant benefit of OHT in patients receiving MCS.
METHODS: Adults listed for OHT in the United Network for Organ Sharing database (6/30/2004-12/31/2011) were stratified by device type. Non-MCS patients were classified as status 1a (n=2536), 1b (n=5827), or 2 (n=8607). The HeartMate I (n=573), HeartMate II (n=1682), and HeartWare (n=66) left ventricular devices (LVAD), the Thoratec (n=298) and Centrimag (n=72) bi-ventricular assist device (BIVAD) systems, and the CardioWest (n=67) total artificial heart (TAH) were assessed. Kaplan-Meier analysis assessed waitlist survival (WLS) and post-transplant survival (PTS); 25th percentile survival times compared the PTS:WLS ratio.
RESULTS: Characteristics for all 19,755 patients were assessed; TAH or BIVAD recipients were younger, had worse functional status, worse hemodynamic parameters, and a higher requirement of additional life support. Figure 1 shows the net transplant benefit for all 9 groups assessed. The PTS:WLS ratio is shown in Table 1. Status 1a recipients had the highest ratio (13.6), compared to 5.1 for status 1b and 2.4 for status 2 patients, 2.0 for HeartMate II LVAD recipients, and 7.0 and 8.3 for Thoratec and Centrimag BIVAD recipients.
CONCLUSION: The net transplant benefit from OHT following HeartMate II LVAD support approaches that of status 2 OHT recipients, while Thoratec and Centrimag BIVAD recipients derive a benefit between status 1b and 1a OHT recipients. HeartWare and CardioWest recipients had low benefit of OHT secondary to their lower than expected post-OHT survival.
- © 2012 by American Heart Association, Inc.