High early event rates in patients with questionable eligibility for advanced heart failure therapies: Results from the Medical Arm of Mechanically Assisted Circulatory Support (Medamacs) Registry

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:35

Article

Ambardekar, Amrut V.¹  Forde-McLean, Rhondalyn C.²  Kittleson, Michelle M.³  Stewart, Garrick C.⁴  Palardy, Maryse⁵  Thibodeau, Jennifer T.⁶  DeVore, Adam D.⁷  Mountis, Maria M.⁸  Cadaret, Linda⁹  Teuteberg, Jeffrey J.¹⁰  Pamboukian, Salpy V.¹¹  Cantor, Ryan S.^12,13  Lindenfeld, JoAnn¹⁴ 

[1] Univ Colorado, Div Cardiol, 12700 East 19th Ave,Campus Box B-139, Aurora, CO 80045 USA

[2] Univ Penn, Dept Med, Philadelphia, PA 19104 USA

[3] Cedars Sinai Heart Inst, Div Cardiol, Los Angeles, CA USA

[4] Brigham & Womens Hosp, Div Cardiovasc Med, 75 Francis St, Boston, MA 02115 USA

[5] Univ Michigan, Dept Internal Med, Div Cardiovasc Med, Ann Arbor, MI 48109 USA

[6] Univ Texas Southwestern Med Ctr, Dept Internal Med, Div Cardiol, Dallas, TX USA

[7] Duke Univ, Sch Med, Div Cardiol, Durham, NC USA

[8] Cleveland Clin, Div Cardiovasc Med, Cleveland, OH 44106 USA

[9] Univ Iowa, Div Cardiol, Iowa City, IA USA

[10] Univ Pittsburgh, Med Ctr, Heart & Vasc Inst, Pittsburgh, PA USA

[11] Univ Alabama Birmingham, Div Cardiovasc Dis, Birmingham, AL 35294 USA

[12] Univ Alabama Birmingham, Div Cardiothorac Surg, Sch Publ Hlth, Birmingham, AL USA

[13] Univ Alabama Birmingham, Dept Epidemiol, Sch Publ Hlth, Birmingham, AL USA

[14] Vanderbilt Heart & Vasc Inst, Nashville, TN USA

关键词: mechanical support;    ventricular assist device;    cardiac transplantation;    destination therapy;    patient selection;   

DOI  :  10.1016/j.healun.2016.01.014

来源: Elsevier

【 摘 要 】

BACKGROUND: The prognosis of ambulatory patients with advanced heart failure (HF) who are not yet inotrope dependent and implications for evaluation and timing for transplant or destination therapy with a left ventricular assist device (DT-LVAD) are unknown. We hypothesized that the characteristics defining eligibility for advanced HF therapies would be a primary determinant of outcomes in these patients. METHODS: Ambulatory patients with advanced HF (New York Heart Association class III-IV, Interagency Registry for Mechanically Assisted Circulatory Support profiles 4-7) were enrolled across 11 centers from May 2013 to February 2015. Patients were stratified into 3 groups: likely transplant eligible, DT-LVAD eligible, and ineligible for both transplant and DT-LVAD. Clinical characteristics were collected, and patients were prospectively followed for death, transplant, and left ventricular assist device implantation. RESULTS: The study enrolled 144 patients with a mean follow-up of 10 6 months. Patients in the ineligible cohort (n = 43) had worse congestion, renal function, and anemia compared with transplant (n = 51) and DT-LVAD (n = 50) eligible patients. Ineligible patients had higher mortality(23.3% vs 8.0% in DT-LVAD group and 5.9% in transplant group, p = 0.02). The differences in mortality were related to lower rates of transplantation (11.8% in transplant group vs 2.0% in DT-LVAD group and 0% in ineligible group, p = 0.02) and left ventricular assist device implantation (15,7% in transplant group vs 2.0% in DT-LVAD group and 0% in ineligible group, p < 0.01). CONCLUSIONS: Ambulatory patients with advanced HF who were deemed ineligible for transplant and DT-LVAD had markers of greater HF severity and a higher rate of mortality compared with patients eligible for transplant or DT-LVAD. The high early event rate in this group emphasizes the need for timely evaluation and decision making regarding lifesaving therapies. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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