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Pre-Transplant LVAD Does Not Adversely Affect One-Year Cardiac Transplant Survival
J. C. Cleveland*, F. L. Grover*, D. A. Fullerton*, D. N. Campbell*, M. B. Mitchell*, J. Lindenfeld, E. E. Wolfel, B. D. Lowes, S. F. Shakar, A. Brieke, A. D. Robertson. University of Colorado Health Sciences, Denver, CO,
BACKGROUND: Left ventricular assist devices (LVADs) are increasingly utilized as a bridge to transplantation (BTT). It remains controversial whether pre-transplant LVAD adversely affects short -term survival following cardiac transplantation.
METHODS: A retrospective review of 317 consecutive patients undergoing cardiac transplantation at our center between 1986 and 2006 was conducted. LVADs were used pre-transplant in 23 of these 317 patients (LVAD), and 294 patients did not require LVAD support (No LVAD). The LVAD patients were supported with either a Heartmate VE or XVE LVAD. Kaplan-Meier survival estimates were compared between the LVAD and No LVAD groups with the Log-Rank test. In addition, occurrence of death was also analyzed between the groups with a Chi square analysis. Results are expressed as one - year survival with 95% confidence interval in parentheses. p<0.05 was considered statistically significant.
RESULTS: The one-year survival for all 317 cardiac transplant patients was 0.86 (0.82, 0.90). The No LVAD patient survival was 0.87 (0.83, 0.90) and the LVAD patient survival was 0.83 (0.67, 0.98), p = 0.77. For the deaths that occurred in the entire 317 patient cohort 19% of the No LVAD patients died within 30 days of transplant, whereas 80% of LVAD patients died within 30 days of transplant(p<0.01).
CONCLUSIONS: When used as BTT, LVAD does not compromise one-year survival following cardiac transplantation. Of patients who die following transplantation, patients bridged with LVAD are at higher risk for death within 30 days of transplant. These data summarize a single-center experience with LVAD as BTT and suggest that LVAD utilization as BTT should be considered for appropriately selected patients awaiting cardiac transplantation.
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