Optimal Timing of Heart Transplant After HeartMate II Left Ventricular Assist Device Implantation
| Autor: | Eugene H. Blackstone, Lucy Thuita, Katherine J. Hoercher, Edward G. Soltesz, Robert J. Steffen, Maria Mountis, Nicholas G. Smedira, Nader Moazami, Randall C. Starling |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Graft Rejection Male Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors Waiting Lists medicine.medical_treatment Clinical Decision-Making 030204 cardiovascular system & hematology Risk Assessment Preoperative care Cohort Studies 03 medical and health sciences Sex Factors 0302 clinical medicine Internal medicine Preoperative Care Humans Medicine 030212 general & internal medicine Dialysis Survival analysis Aged Retrospective Studies Heart Failure Heart transplantation business.industry Age Factors Transplant Waiting List Middle Aged Prognosis medicine.disease Survival Analysis Surgery Transplantation Ventricular assist device Heart failure Cardiology Heart Transplantation Female Heart-Assist Devices Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 104:1569-1576 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2017.03.066 |
| Popis: | Background Optimal timing of heart transplantation in patients supported with second-generation left ventricular assist devices (LVADs) is unknown. Despite this, patients with LVADs continue to receive priority on the heart transplant waiting list. Our objective was to determine the optimal timing of transplantation for patients bridged with continuous-flow LVADs. Methods A total of 301 HeartMate II LVADs (Thoratec Corp, Pleasanton, CA) were implanted in 285 patients from October 2004 to June 2013, and 86 patients underwent transplantation through the end of follow-up. Optimal transplantation timing was the product of surviving on LVAD support and surviving transplant. Results Three-year survival after both HeartMate II implantation and heart transplantation was unchanged when transplantation occurred within 9 months of implantation. Survival decreased as the duration of support exceeded this. Preoperative risk factors for death on HeartMate II support were prior valve operation, prior coronary artery bypass grafting, low albumin, low glomerular filtration rate, higher mean arterial pressure, hypertension, and earlier date of implant. Survival for patients without these risk factors was lowest when transplant was performed within 3 months but was relatively constant with increased duration of support. Longer duration of support was associated with poorer survival for patients with many of these risk factors. Device reimplantation, intracranial hemorrhage, and postimplant dialysis during HeartMate II support were associated with decreased survival. Conclusions Survival of patients supported by the HeartMate II is affected by preoperative comorbidities and postoperative complications. Transplantation before complications is imperative in optimizing survival. |
| Databáze: | OpenAIRE |
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