Duration of Left Ventricular Assist Device Support Does Not Impact Survival After US Heart Transplantation

Joshua C. Grimm, J. Trent Magruder, Todd C. Crawford, Charles D. Fraser, William G. Plum, Christopher M. Sciortino, Robert Higgins, Glenn Whitman, Ashish S. Shah

Research output: Contribution to journalArticle

Abstract

Background The aim of this study was to determine whether the duration of left ventricular device support (LVAD) influenced outcomes after orthotopic heart transplantation in a modern, bridge to transplant national cohort. Methods The United Network for Organ Sharing database, which has recently made pretransplant LVAD duration available, was queried for all adult bridge to transplant patients between January 2011 and December 2012. Three LVAD duration cohorts were generated, as follows: short (less than 90 days), intermediate (90 to 365 days), and prolonged (more than 365 days). Recipient, donor, and transplant-specific characteristics were compared among the duration cohorts. Unadjusted short-term and long-term survivals were estimated with the Kaplan-Meier method. Risk-adjusted models were also constructed to determine the independent impact of device duration on mortality. Results Of the 1,332 patients who met criteria for inclusion, 9.8% (n = 130), 54.7% (n = 729), and 35.5% (n = 473) were classified as short, intermediate, and prolonged, respectively. Although the performance status across each cohort was similar at listing (p = 0.38), more patients in the intermediate and prolonged cohorts were considered functionally independent before orthotopic heart transplantation (32% and 37%, respectively, versus 18%; p < 0.001). Additionally, despite worse baseline renal function in the intermediate and prolonged cohorts relative to the short cohort (glomerular filtration rate, 57 and 57 versus 69, p < 0.001), there was no difference in the incidence of new onset posttransplant renal failure (7% versus 10%, 9%, p = 0.41). There was also no difference in 30-day survival (98%, 96%, 95%, p = 0.51), 6-month survival (93%, 92%, 92%, p = 0.93), or 1-year survival (91%, 89%, 89%, p = 0.78) across the cohorts. After risk adjustment, duration did not independently predict mortality at any timepoint. Conclusions In the largest, non–industry sponsored study of a modern bridge to transplant cohort, we demonstrated that duration of LVAD support before orthotopic heart transplantation does not influence posttransplant morbidity or mortality. In subanalysis, support for 90 days or more is associated with improvements in pretransplant functional performance.

Original languageEnglish (US)
Pages (from-to)1206-1212
Number of pages7
JournalAnnals of Thoracic Surgery
Volume102
Issue number4
DOIs
StatePublished - Oct 1 2016

Fingerprint

Heart-Assist Devices
Heart Transplantation
Equipment and Supplies
Survival
Transplants
Mortality
Risk Adjustment
Glomerular Filtration Rate
Renal Insufficiency
Tissue Donors
Databases
Morbidity
Kidney
Incidence

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Grimm, J. C., Magruder, J. T., Crawford, T. C., Fraser, C. D., Plum, W. G., Sciortino, C. M., ... Shah, A. S. (2016). Duration of Left Ventricular Assist Device Support Does Not Impact Survival After US Heart Transplantation. Annals of Thoracic Surgery, 102(4), 1206-1212. https://doi.org/10.1016/j.athoracsur.2016.04.022

Duration of Left Ventricular Assist Device Support Does Not Impact Survival After US Heart Transplantation. / Grimm, Joshua C.; Magruder, J. Trent; Crawford, Todd C.; Fraser, Charles D.; Plum, William G.; Sciortino, Christopher M.; Higgins, Robert; Whitman, Glenn; Shah, Ashish S.

In: Annals of Thoracic Surgery, Vol. 102, No. 4, 01.10.2016, p. 1206-1212.

Research output: Contribution to journalArticle

Grimm, Joshua C. ; Magruder, J. Trent ; Crawford, Todd C. ; Fraser, Charles D. ; Plum, William G. ; Sciortino, Christopher M. ; Higgins, Robert ; Whitman, Glenn ; Shah, Ashish S. / Duration of Left Ventricular Assist Device Support Does Not Impact Survival After US Heart Transplantation. In: Annals of Thoracic Surgery. 2016 ; Vol. 102, No. 4. pp. 1206-1212.
@article{f5972f42073c4d76ae64ceeaa43e4987,
title = "Duration of Left Ventricular Assist Device Support Does Not Impact Survival After US Heart Transplantation",
abstract = "Background The aim of this study was to determine whether the duration of left ventricular device support (LVAD) influenced outcomes after orthotopic heart transplantation in a modern, bridge to transplant national cohort. Methods The United Network for Organ Sharing database, which has recently made pretransplant LVAD duration available, was queried for all adult bridge to transplant patients between January 2011 and December 2012. Three LVAD duration cohorts were generated, as follows: short (less than 90 days), intermediate (90 to 365 days), and prolonged (more than 365 days). Recipient, donor, and transplant-specific characteristics were compared among the duration cohorts. Unadjusted short-term and long-term survivals were estimated with the Kaplan-Meier method. Risk-adjusted models were also constructed to determine the independent impact of device duration on mortality. Results Of the 1,332 patients who met criteria for inclusion, 9.8{\%} (n = 130), 54.7{\%} (n = 729), and 35.5{\%} (n = 473) were classified as short, intermediate, and prolonged, respectively. Although the performance status across each cohort was similar at listing (p = 0.38), more patients in the intermediate and prolonged cohorts were considered functionally independent before orthotopic heart transplantation (32{\%} and 37{\%}, respectively, versus 18{\%}; p < 0.001). Additionally, despite worse baseline renal function in the intermediate and prolonged cohorts relative to the short cohort (glomerular filtration rate, 57 and 57 versus 69, p < 0.001), there was no difference in the incidence of new onset posttransplant renal failure (7{\%} versus 10{\%}, 9{\%}, p = 0.41). There was also no difference in 30-day survival (98{\%}, 96{\%}, 95{\%}, p = 0.51), 6-month survival (93{\%}, 92{\%}, 92{\%}, p = 0.93), or 1-year survival (91{\%}, 89{\%}, 89{\%}, p = 0.78) across the cohorts. After risk adjustment, duration did not independently predict mortality at any timepoint. Conclusions In the largest, non–industry sponsored study of a modern bridge to transplant cohort, we demonstrated that duration of LVAD support before orthotopic heart transplantation does not influence posttransplant morbidity or mortality. In subanalysis, support for 90 days or more is associated with improvements in pretransplant functional performance.",
author = "Grimm, {Joshua C.} and Magruder, {J. Trent} and Crawford, {Todd C.} and Fraser, {Charles D.} and Plum, {William G.} and Sciortino, {Christopher M.} and Robert Higgins and Glenn Whitman and Shah, {Ashish S.}",
year = "2016",
month = "10",
day = "1",
doi = "10.1016/j.athoracsur.2016.04.022",
language = "English (US)",
volume = "102",
pages = "1206--1212",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "4",

}

TY - JOUR

T1 - Duration of Left Ventricular Assist Device Support Does Not Impact Survival After US Heart Transplantation

AU - Grimm, Joshua C.

AU - Magruder, J. Trent

AU - Crawford, Todd C.

AU - Fraser, Charles D.

AU - Plum, William G.

AU - Sciortino, Christopher M.

AU - Higgins, Robert

AU - Whitman, Glenn

AU - Shah, Ashish S.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background The aim of this study was to determine whether the duration of left ventricular device support (LVAD) influenced outcomes after orthotopic heart transplantation in a modern, bridge to transplant national cohort. Methods The United Network for Organ Sharing database, which has recently made pretransplant LVAD duration available, was queried for all adult bridge to transplant patients between January 2011 and December 2012. Three LVAD duration cohorts were generated, as follows: short (less than 90 days), intermediate (90 to 365 days), and prolonged (more than 365 days). Recipient, donor, and transplant-specific characteristics were compared among the duration cohorts. Unadjusted short-term and long-term survivals were estimated with the Kaplan-Meier method. Risk-adjusted models were also constructed to determine the independent impact of device duration on mortality. Results Of the 1,332 patients who met criteria for inclusion, 9.8% (n = 130), 54.7% (n = 729), and 35.5% (n = 473) were classified as short, intermediate, and prolonged, respectively. Although the performance status across each cohort was similar at listing (p = 0.38), more patients in the intermediate and prolonged cohorts were considered functionally independent before orthotopic heart transplantation (32% and 37%, respectively, versus 18%; p < 0.001). Additionally, despite worse baseline renal function in the intermediate and prolonged cohorts relative to the short cohort (glomerular filtration rate, 57 and 57 versus 69, p < 0.001), there was no difference in the incidence of new onset posttransplant renal failure (7% versus 10%, 9%, p = 0.41). There was also no difference in 30-day survival (98%, 96%, 95%, p = 0.51), 6-month survival (93%, 92%, 92%, p = 0.93), or 1-year survival (91%, 89%, 89%, p = 0.78) across the cohorts. After risk adjustment, duration did not independently predict mortality at any timepoint. Conclusions In the largest, non–industry sponsored study of a modern bridge to transplant cohort, we demonstrated that duration of LVAD support before orthotopic heart transplantation does not influence posttransplant morbidity or mortality. In subanalysis, support for 90 days or more is associated with improvements in pretransplant functional performance.

AB - Background The aim of this study was to determine whether the duration of left ventricular device support (LVAD) influenced outcomes after orthotopic heart transplantation in a modern, bridge to transplant national cohort. Methods The United Network for Organ Sharing database, which has recently made pretransplant LVAD duration available, was queried for all adult bridge to transplant patients between January 2011 and December 2012. Three LVAD duration cohorts were generated, as follows: short (less than 90 days), intermediate (90 to 365 days), and prolonged (more than 365 days). Recipient, donor, and transplant-specific characteristics were compared among the duration cohorts. Unadjusted short-term and long-term survivals were estimated with the Kaplan-Meier method. Risk-adjusted models were also constructed to determine the independent impact of device duration on mortality. Results Of the 1,332 patients who met criteria for inclusion, 9.8% (n = 130), 54.7% (n = 729), and 35.5% (n = 473) were classified as short, intermediate, and prolonged, respectively. Although the performance status across each cohort was similar at listing (p = 0.38), more patients in the intermediate and prolonged cohorts were considered functionally independent before orthotopic heart transplantation (32% and 37%, respectively, versus 18%; p < 0.001). Additionally, despite worse baseline renal function in the intermediate and prolonged cohorts relative to the short cohort (glomerular filtration rate, 57 and 57 versus 69, p < 0.001), there was no difference in the incidence of new onset posttransplant renal failure (7% versus 10%, 9%, p = 0.41). There was also no difference in 30-day survival (98%, 96%, 95%, p = 0.51), 6-month survival (93%, 92%, 92%, p = 0.93), or 1-year survival (91%, 89%, 89%, p = 0.78) across the cohorts. After risk adjustment, duration did not independently predict mortality at any timepoint. Conclusions In the largest, non–industry sponsored study of a modern bridge to transplant cohort, we demonstrated that duration of LVAD support before orthotopic heart transplantation does not influence posttransplant morbidity or mortality. In subanalysis, support for 90 days or more is associated with improvements in pretransplant functional performance.

UR - http://www.scopus.com/inward/record.url?scp=84990212943&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84990212943&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2016.04.022

DO - 10.1016/j.athoracsur.2016.04.022

M3 - Article

C2 - 27319984

AN - SCOPUS:84990212943

VL - 102

SP - 1206

EP - 1212

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 4

ER -