Adult Heart Transplantation Following Ventricular Assist Device Implantation: Early and Late Outcomes
| Autor: | Danny Ramzy, Francisco A. Arabia, Heidi Reich, Jon A. Kobashigawa, Lawrence S.C. Czer, M. Awad, J. D. Moriguchi, Alfredo Trento, James Mirocha, Matthew Rafiei, Fardad Esmailian, A. Ruzza, M. De Robertis |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.medical_treatment California law.invention chemistry.chemical_compound Risk Factors law Internal medicine parasitic diseases Humans Medicine cardiovascular diseases Risk factor Dialysis Proportional Hazards Models Heart Failure Heart transplantation Transplantation Creatinine business.industry Hazard ratio Length of Stay Middle Aged Intensive care unit Surgery Cardiac surgery Survival Rate Treatment Outcome chemistry Ventricular assist device Cardiology Heart Transplantation Female Heart-Assist Devices biological phenomena cell phenomena and immunity business |
| Zdroj: | Transplantation Proceedings. 48:158-166 |
| ISSN: | 0041-1345 |
| Popis: | The impact of prior implantation of a ventricular assist device (VAD) on short- and long-term postoperative outcomes of adult heart transplantation (HTx) was investigated.Of the 359 adults with prior cardiac surgery who underwent HTx from December 1988 to June 2012 at our institution, 90 had prior VAD and 269 had other (non-VAD) prior cardiac surgery.The VAD group had a lower 60-day survival when compared with the Non-VAD group (91.1% ± 3.0% vs 96.6% ± 1.1%; P = .03). However, the VAD and Non-VAD groups had similar survivals at 1 year (87.4% ± 3.6% vs 90.5% ± 1.8%; P = .33), 2 years (83.2% ± 4.2% vs 88.1% ± 2.0%; P = .21), 5 years (75.7% ± 5.6% vs 74.6% ± 2.9%; P = .63), 10 years (38.5% ± 10.8% vs 47.6% ± 3.9%; P = .33), and 12 years (28.9% ± 11.6% vs 39.0% ± 4.0%; P = .36). The VAD group had longer pump time and more intraoperative blood use when compared with the Non-VAD group (P.0001 for both). Postoperatively, VAD patients had higher frequencies of48-hour ventilation and in-hospital infections (P = .0007 and .002, respectively). In addition, more VAD patients had sternal wound infections when compared with Non-VAD patients (8/90 [8.9%] vs 5/269 [1.9%]; P = .005). Both groups had similar lengths of intensive care unit (ICU) and hospital stays and no differences in the frequencies of reoperation for chest bleeding, dialysis, and postdischarge infections (P = .19, .70, .34, .67, and .21, respectively). Postoperative creatinine levels at peak and at discharge did not differ between the 2 groups (P = .51 and P = .098, respectively). In a Cox model, only preoperative creatinine ≥1.5 mg/dL (P = .006) and intraoperative pump time ≥210 minutes (P = .022) were individually considered as significant predictors of mortality within 12 years post-HTx. Adjusting for both, pre-HTx VAD implantation was not a predictor of mortality within 12 years post-HTx (hazard ratio [HR], 1.23; 95% confidence interval [CI], 0.77-1.97; P = .38). However, pre-HTx VAD implantation was a risk factor for 60-day mortality (HR, 2.86; 95% CI, 1.07-7.62; P = .036) along with preoperative creatinine level ≥2 mg/dL (P = .0006).HTx patients with prior VAD had lower 60-day survival, higher intraoperative blood use, and greater frequency of postoperative in-hospital infections when compared with HTx patients with prior Non-VAD cardiac surgery. VAD implantation prior to HTx did not have an additional negative impact on long-term morbidity and survival following HTx. Long-term (1-, 2-, 5-, 10-, and 12-year) survival did not differ significantly in HTx patients with prior VAD or non-VAD cardiac surgery. |
| Databáze: | OpenAIRE |
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