Abstract 17262: Outcomes following High Risk Surgery provided as an Alternative to Transplant in patients with End-stage Heart Disease
Background: Heart transplant (Tx) and ventricular assist device (VAD) have become established treatments for end stage heart failure; however, both treatments still have unsolved problems. Patients referred for Tx or VAD are often found to have cardiac lesions amenable to surgical intervention. We examined the results of conventional surgery in patients with severe left ventricular dysfunction to explore the possibility of high risk surgery as an alternative option.
Methods: We reviewed our institutional database and identified all surgical patients referred to our senior author with severe LV dysfunction (EF<20%). We then selected patients who were initially referred for consideration of Tx or VAD, but were instead offered conventional surgery. All patients underwent evaluation for Tx candidacy and thus were prospectively stratified into Tx eligible (Tx-E) or Tx non-eligible (Tx-NE) groups. We compared outcomes stratified by Tx eligibility as well as by type of surgery.
Results: A total of 133 patients were enrolled. 68 patients were Tx-E, and 65 were Tx-NE. Tx-E patients were younger than Tx-NE (57±8 vs 70±8 year-old, p<0.01). Isolated CABG was performed in 77 patients, while 56 had other procedures. In-hospital mortality was 8.8% in Tx-E, and 15.4% in Tx-NE (p=0.29). Kaplan-Meier analysis demonstrated that survival in Tx-E was comparable to ISHLT Tx data, while survival in Tx-NE was comparable to INTERMACS DT data (Figure1). When stratified by type of surgery, in-hospital mortality was lower for isolated CABG (6.5% vs 19.6%, p=0.03). Isolated CABG seemed to have comparable survival to ISHLT Tx and INTERMACS DT by Kaplan-Meier analysis (Figure2).
Conclusion: The mortality and morbidity in patients undergoing alternative surgeries appears to be similar to the contemporary results of Tx and VAD destination therapy. Particularly if the pathology of heart failure is graftable coronary artery disease, isolated CABG may be a good option for highly selected patients.
Author Disclosures: H. Kawajiri: None. L. Garrard: None. C. Manlhiot: None. H. Ross: None. D. Delgado: None. F. Billia: None. M. McDonald: None. V. Rao: None.
- © 2014 by American Heart Association, Inc.