TY - JOUR
T1 - Left Ventricular Assist Device Exchange Increases Heart Transplant Wait-List Mortality
AU - Suarez-Pierre, Alejandro
AU - Stevens, Kent
AU - Giuliano, Katherine
AU - Lui, Cecillia
AU - Fraser, Charles D.
AU - Choi, Chun W.
AU - Higgins, Robert S.
AU - Kilic, Ahmet
N1 - Funding Information:
This work was supported in part by Health Resources and Services Administration, United States contract 234-2005-37011C. This content is the responsibility of the authors alone and does not necessarily reflect the view or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.
Funding Information:
This work was supported in part by Health Resources and Services Administration, United States contract 234-2005-37011C. This content is the responsibility of the authors alone and does not necessarily reflect the view or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. Author contributions: Study design ? ASP, EE, KG, CL, CDF, TCC, CWC, RSH, AK; Analysis and interpretation of data ? ASP, EE, KG, CL, CDF, TCC, CWC, RSH, AK; Drafting of article ? ASP, AK; Critical revision ? ASP, EE, KG, CL, CDF, TCC, CWC, RSH, AK.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/11
Y1 - 2020/11
N2 - Background: The new heart transplant allocation criteria prioritize inpatients who require temporary mechanical circulatory support and give lower urgency to candidates on a durable left ventricular assist device (LVAD) who require a device exchange. This study explores whether the latter group should warrant higher priority to reduce wait-list mortality. Methods: This is a retrospective observational study of 13,113 adult heart transplant candidates in the Organ Procurement and Transplantation Network database who underwent LVAD implantation between 2007 and 2017. It evaluates the impact of LVAD exchange on the composite endpoint of death or removal from the wait list owing to worsening medical condition 1 y after device implantation. Results: There were 1085 pump exchanges in 954 patients (7% of candidates), of which 22% were women. The pump exchange rate was 5.92 events per 100 patient-years. One-year survival was lower for those who required a pump exchange (76.3% versus 88.5%, logrank P < 0.001). This was congruent with the risk-adjusted mortality 1-y after implantation (hazards ratio: 2.56, 95% confidence interval: 2.18-3.00, P < 0.001). Conclusions: These findings indicate that among candidates awaiting heart transplantation with a durable LVAD, undergoing pump exchange doubles the risk of 1-y mortality. Giving priority to these candidates may reduce wait-list mortality.
AB - Background: The new heart transplant allocation criteria prioritize inpatients who require temporary mechanical circulatory support and give lower urgency to candidates on a durable left ventricular assist device (LVAD) who require a device exchange. This study explores whether the latter group should warrant higher priority to reduce wait-list mortality. Methods: This is a retrospective observational study of 13,113 adult heart transplant candidates in the Organ Procurement and Transplantation Network database who underwent LVAD implantation between 2007 and 2017. It evaluates the impact of LVAD exchange on the composite endpoint of death or removal from the wait list owing to worsening medical condition 1 y after device implantation. Results: There were 1085 pump exchanges in 954 patients (7% of candidates), of which 22% were women. The pump exchange rate was 5.92 events per 100 patient-years. One-year survival was lower for those who required a pump exchange (76.3% versus 88.5%, logrank P < 0.001). This was congruent with the risk-adjusted mortality 1-y after implantation (hazards ratio: 2.56, 95% confidence interval: 2.18-3.00, P < 0.001). Conclusions: These findings indicate that among candidates awaiting heart transplantation with a durable LVAD, undergoing pump exchange doubles the risk of 1-y mortality. Giving priority to these candidates may reduce wait-list mortality.
KW - Heart transplantation
KW - Left ventricular assist device exchange
KW - Pump exchange
KW - Transplant candidate
KW - Ventricular assist device
KW - Waitlist mortality
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U2 - 10.1016/j.jss.2020.05.062
DO - 10.1016/j.jss.2020.05.062
M3 - Article
C2 - 32570131
AN - SCOPUS:85086506055
SN - 0022-4804
VL - 255
SP - 277
EP - 284
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -