Predictors of survival in patients bridged to transplantation with the Thoratec VAD device: a single-center retrospective study on more than 100 patients

doi:10.1016/S1053-2498(00)00174-1

The Journal of Heart and Lung Transplantation

Volume 19, Issue 10, October 2000, Pages 964-968

https://doi.org/10.1016/S1053-2498(00)00174-1 Get rights and content

Abstract

Background: Careful patient selection markedly influences the outcome of patients who undergo mechanical circulatory support. Therefore, we tried to evaluate predictors of survival after implantation of the Thoratec ventricular assist device (VAD).

Methods

Between October 1992 and January 2000, 104 patients (86 men, 18 women, aged 11 to 69 years) received the Thoratec VAD as a bridge to transplant. A total of 51 patients required left ventricular support (LVAD), 50 patients required biventricular support (BVAD), and 3 patients required total artificial heart implantation. We performed univariate analysis of 25 parameters with regard to their effect on survival and then applied a multivariate analysis to evaluate those factors that turned out to be marginally significant. We performed all analysis for the total collective as well as for the LVAD and BVAD sub-group.

Results

The BVAD patients tended to have worse outcomes than did LVAD patients. We found no significant predictors of survival in either sub-group. In the total collective, however, we found the following pre-implant conditions were independent risk factors for survival after VAD implantation: patient age > 60 years (odds ratio [OR] 3.87, confidence interval [CI] 1.39 to 10.76), pre-implant ventilation (OR, 6.76; CI 2.42 to 18.84), and increased pre-implant total bilirubin (OR, 1.42; CL, 1.19 to 1.69).

Conclusions

Transplant candidates on inotropic support should be considered for bridging to transplant as soon as bilirubin values start to increase or before respiratory function deteriorates and ventilation becomes necessary. In elderly patients, careful patient selection, particularly considering potential risk factors, might favorably affect their outcomes.

Section snippets

Patients and methods

Between October 1992 and January 2000, 140 patients were supported with the Thoratec device at our institution; 108 of them received the system as a bridge to transplant. Ninety-seven patients received exclusive Thoratec support; 7 patients were first supported with the centrifugal pump, which was then replaced by Thoratec; and 4 patients had Thoratec devices implanted for right ventricular support in addition to left ventricular assist devices. We excluded these 4 patients from our study

Results

Duration of support was 57.4 ± 61.6 days for LVAD and 55.4 ± 46.5 days for BVAD patients. The BVAD sub-group was generally more multi-morbid as reflected by pre-operative renal and liver function parameters (BUN, total bilirubin, SGOT, SGPT), although only total bilirubin showed a significant difference in comparison with LVAD patients (Table I). Post-operatively, we found a significantly higher incidence of bleeding complications in the BVAD group (a bleeding complication was defined as blood

Discussion

The Thoratec VAD is a versatile, FDA-approved system; currently more than 1,300 have been implanted in 120 centers worldwide. This report describes a large single-center study with more than 100 patients within 8 years. We performed our analysis on a homogenous patient collective, all of whom were in imminent risk of death before cardiac transplantation. The ratio between BVAD and LVAD patients within this collective is not representative for the total VAD cohort; because of long waiting times

Acknowledgements

Grant support was given by the German Association of Organ Recipients (Registered Association).

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Citation Excerpt :
Although there was a survival advantage demonstrated in the REMATCH study, the outcomes led many to question whether the increased length of life was worth the expense to both the patients and the health care system. Another factor is age, which has consistently been identified in multiple studies as a risk factor for decreased survival and increased adverse events after LVAD placement (7–22). However, these previous studies have significant limitations.
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Food and Drug Administration approval of the HeartMate II (Thoratec Corporation, Pleasanton, California) LVAD for destination therapy has provided an attractive option for older patients with advanced heart failure.
Fifty-five patients received the HeartMate II LVAD between October 5, 2005, and January 1, 2010, as part of either the bridge to transplantation or destination therapy trials at a community hospital. Patients were divided into 2 age groups: ≥70 years of age (n = 30) and <70 years of age (n = 25). Outcome measures including survival, length of hospital stay, adverse events, and quality of life were compared between the 2 groups.
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The cumulative survival rates for the LVAD patients were 75% at 30 days, 46% at 180 days and 39% at 1 year after VAD implantation. The cumulative survival rates at 30 days, 180 days and 1 year were 71%, 47% and 35% for INTERMACS Level I to III (n = 17) patients vs 81%, 45% and 45% for INTERMACS Level IV to V (n = 11) patients (p = 0.9), respectively. Median age of LVAD recipients was 69 (range 66 to 80) years; 4 were women. Median support time was 565 (range 228 to 1,257) days. In 9 recipients support is ongoing. Both complications profiles and causes of death are reported.
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Mechanical circulatory supportPredictors of survival in patients bridged to transplantation with the Thoratec VAD device: a single-center retrospective study on more than 100 patients

Abstract

Methods

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Acknowledgements

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardivasc Surg

Ann Thorac Surg

Mechanical circulatory support
Predictors of survival in patients bridged to transplantation with the Thoratec VAD device: a single-center retrospective study on more than 100 patients