Impact of bridge-to-bridge strategies from paracorporeal to implantable left ventricular assist devices on the pre-heart transplant outcome: A single-center analysis of 134 cases
| Autor: | Seiko Nakajima Doi, Junjiro Kobayashi, Tomoyuki Fujita, Satsuki Fukushima, Keiichiro Iwasaki, Osamu Seguchi, Masahiro Yamamoto, Yuto Kumai, Kensuke Kuroda, Masanobu Yanase, Hiroki Mochizuki, Yuki Kimura, Koichi Toda, Takeshi Kimura, Takuya Watanabe, Norihide Fukushima |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans 030212 general & internal medicine Stroke Survival rate Retrospective Studies Heart Failure Heart transplantation business.industry Mortality rate Cardiogenic shock Hazard ratio medicine.disease Survival Rate Treatment Outcome Ventricular assist device Heart failure Cardiology Heart Transplantation Heart-Assist Devices Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Cardiology. 77:408-416 |
| ISSN: | 0914-5087 |
| Popis: | Background In Japan, patients with heart failure who have a paracorporeal left ventricular assist device (pLVAD) and cannot be weaned from the VAD may undergo conversion to implantable continuous-flow LVAD (iLVAD) via a bridge-to-bridge (BTB) strategy for bridge-to-transplantation (BTT). This study aimed to evaluate the real-world clinical status of BTB strategies. Methods Among 134 patients who underwent iLVAD implantation for BTT, 34 patients underwent conversion from pLVAD to iLVAD (BTB group) and 100 patients underwent iLVAD implantation primarily (primary iLVAD group). The clinical characteristics and outcomes were compared between the two groups. Results No significant difference was found in the overall survival between the two groups (p = 0.26; log-rank test). However, the 1-year survival rate and the 1-year freedom from the composite events of death, stroke, systemic infection, and bleeding rate were lower in the BTB group than in the primary iLVAD group (survival rate, 88.2% vs. 99.0%, p = 0.0040; composite event-free survival rate, 26.1% vs. 49.8%, p = 0.030; log-rank test). Multivariate analysis indicated that the BTB strategy [hazard ratio (HR) 1.70, 95% confidence intervals (CI) 1.03–2.72; p=0.036] and serum total bilirubin levels at iLVAD implantation [HR 1.31, 95% CI 1.00–1.65; p=0.043] were independent predictors of 1-year composite events. Conclusions The BTB strategy is useful in providing long-term survival in patients with acute critical diseases. However, the early mortality rate after conversion is higher in patients who underwent the BTB strategy. |
| Databáze: | OpenAIRE |
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