Predictors of 30-day post-transplant mortality in patients bridged to transplantation with continuous-flow left ventricular assist devices-An analysis of the International Society for Heart and Lung Transplantation Transplant Registry

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:35

Article

Healy, Aaron H.¹  Stehlik, Josef²  Edwards, Leah B.³  McKellar, Stephen H.¹  Drakos, Stavros G.²  Selzman, Craig H.¹ 

[1] Univ Utah, Dept Surg, Salt Lake City, UT USA

[2] Univ Utah, Dept Med, Salt Lake City, UT 84112 USA

[3] Int Soc Heart & Lung Transplantat, Addison, TX USA

关键词: ventricular assist device;    transplantation;    outcomes;    continuous flow;    bridge to transplant;   

DOI  :  10.1016/j.healun.2015.07.007

来源: Elsevier

【 摘 要 】

BACKGROUND: Continuous-flow (CF) left ventricular assist devices (LVADs) are standard of care for bridging patients to cardiac transplantation. However, existing data about preoperative factors influencing early post-transplant survival in these patients are limited. We sought to determine risk factors for mortality using a large international database. METHODS: All patients in the International Society for Heart and Lung Transplantation Transplant Registry who were bridged to transplantation with CF LVADs between June 2008 and June 2012 were included. Risk factors for mortality within 30 days of transplant were identified. Statistical analysis included multivariable analysis and Kaplan-Meier survival analysis. RESULTS: During the study period, 2,152 patients with CF LVADs underwent heart transplantation. Post transplant survival was 95.5% at 30 days. Risk factors for mortality during this window included ventilator support at transplant (hazard ratio [HR] = 5.00, 95% confidence interval [CI] = 1.51-16.58), female recipient/male donor (compared with all other combinations, HR = 3.29, 95% CI = 1.90-5.72), history of hemodialysis (HR = 2.51, 95% CI = 1.14-5.51), and history of coronary bypass grafting (HR = 1.89, 95% CI = 1.19-3.00). Increasing recipient age (p = 0.002), body mass index (p = 0.002), creatinine (p = 0.004), and total bilirubin (p < 0.001) also were associated with an increase in mortality. CONCLUSIONS: In patients supported with CF LVADs, risk factors for early mortality can be identified before transplant, including ventilator support, female recipient/male donor, increasing recipient age, and body mass index. Despite the inherent complexities of a reoperative surgery, patients bridged to transplant with CF LVADs have excellent peri-operative survival. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

Free