Outcomes in Patients Bridged With Univentricular and Biventricular Devices in the Modern Era of Heart Transplantation

Joshua C. Grimm, Christopher M. Sciortino, J. Trent Magruder, Samuel P. Dungan, Vicente Valero, Kavita Sharma, Ryan J. Tedford, Stuart D. Russell, Glenn Whitman, Scott C. Silvestry, Ashish S. Shah

Research output: Contribution to journalArticle

Abstract

Background: Biventricular support before orthotopic heart transplantation (OHT) has been shown to adversely affect short- and long-term outcomes, but the comparative effect of support type is largely unknown. This study determined the comparative effect of univentricular and biventricular support on survival in bridged patients after OHT. Methods: The United Network of Organ Sharing database was queried for adult patients bridged to OHT with a univentricular (left ventricular assist device [LVAD]), biventricular (biventricular assist device [BiVAD]), or total artificial heart ([TAH]) device between 2004 and 2012. Unconditional and conditional survivals were compared with the Kaplan-Meier method. Cox proportional hazards regression models were constructed to determine the risk-adjusted influence of support type on death. Results: Of the 4,177 patients identified, 3,457 (20.4%), 575 (3.4%), and 145 (0.9%) were bridged with an LVAD, BiVAD, and TAH, respectively. Unadjusted 30-day, 1-year, and 5-year estimated survival was greater in LVAD patients than in the BiVAD and TAH cohorts. After risk-adjustment, BiVAD and TAH were associated with an increased risk of death at all time points. Unadjusted and adjusted 5-year survival, conditional on 1-year survival, was worse, however, in only TAH patients. Conclusions: Patients with biventricular failure bridged to OHT with a TAH or BiVAD experience worse short- and long-term survival comparison with those with an LVAD. This difference is most likely due to an increase in early death and depends on the type of BiVAD device implanted.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - 2016
Externally publishedYes

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Heart Transplantation
Artificial Heart
Equipment and Supplies
Heart-Assist Devices
Survival
Risk Adjustment
Proportional Hazards Models
Databases

ASJC Scopus subject areas

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

Cite this

Outcomes in Patients Bridged With Univentricular and Biventricular Devices in the Modern Era of Heart Transplantation. / Grimm, Joshua C.; Sciortino, Christopher M.; Magruder, J. Trent; Dungan, Samuel P.; Valero, Vicente; Sharma, Kavita; Tedford, Ryan J.; Russell, Stuart D.; Whitman, Glenn; Silvestry, Scott C.; Shah, Ashish S.

In: Annals of Thoracic Surgery, 2016.

Research output: Contribution to journalArticle

Grimm, Joshua C. ; Sciortino, Christopher M. ; Magruder, J. Trent ; Dungan, Samuel P. ; Valero, Vicente ; Sharma, Kavita ; Tedford, Ryan J. ; Russell, Stuart D. ; Whitman, Glenn ; Silvestry, Scott C. ; Shah, Ashish S. / Outcomes in Patients Bridged With Univentricular and Biventricular Devices in the Modern Era of Heart Transplantation. In: Annals of Thoracic Surgery. 2016.
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abstract = "Background: Biventricular support before orthotopic heart transplantation (OHT) has been shown to adversely affect short- and long-term outcomes, but the comparative effect of support type is largely unknown. This study determined the comparative effect of univentricular and biventricular support on survival in bridged patients after OHT. Methods: The United Network of Organ Sharing database was queried for adult patients bridged to OHT with a univentricular (left ventricular assist device [LVAD]), biventricular (biventricular assist device [BiVAD]), or total artificial heart ([TAH]) device between 2004 and 2012. Unconditional and conditional survivals were compared with the Kaplan-Meier method. Cox proportional hazards regression models were constructed to determine the risk-adjusted influence of support type on death. Results: Of the 4,177 patients identified, 3,457 (20.4{\%}), 575 (3.4{\%}), and 145 (0.9{\%}) were bridged with an LVAD, BiVAD, and TAH, respectively. Unadjusted 30-day, 1-year, and 5-year estimated survival was greater in LVAD patients than in the BiVAD and TAH cohorts. After risk-adjustment, BiVAD and TAH were associated with an increased risk of death at all time points. Unadjusted and adjusted 5-year survival, conditional on 1-year survival, was worse, however, in only TAH patients. Conclusions: Patients with biventricular failure bridged to OHT with a TAH or BiVAD experience worse short- and long-term survival comparison with those with an LVAD. This difference is most likely due to an increase in early death and depends on the type of BiVAD device implanted.",
author = "Grimm, {Joshua C.} and Sciortino, {Christopher M.} and Magruder, {J. Trent} and Dungan, {Samuel P.} and Vicente Valero and Kavita Sharma and Tedford, {Ryan J.} and Russell, {Stuart D.} and Glenn Whitman and Silvestry, {Scott C.} and Shah, {Ashish S.}",
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T1 - Outcomes in Patients Bridged With Univentricular and Biventricular Devices in the Modern Era of Heart Transplantation

AU - Grimm, Joshua C.

AU - Sciortino, Christopher M.

AU - Magruder, J. Trent

AU - Dungan, Samuel P.

AU - Valero, Vicente

AU - Sharma, Kavita

AU - Tedford, Ryan J.

AU - Russell, Stuart D.

AU - Whitman, Glenn

AU - Silvestry, Scott C.

AU - Shah, Ashish S.

PY - 2016

Y1 - 2016

N2 - Background: Biventricular support before orthotopic heart transplantation (OHT) has been shown to adversely affect short- and long-term outcomes, but the comparative effect of support type is largely unknown. This study determined the comparative effect of univentricular and biventricular support on survival in bridged patients after OHT. Methods: The United Network of Organ Sharing database was queried for adult patients bridged to OHT with a univentricular (left ventricular assist device [LVAD]), biventricular (biventricular assist device [BiVAD]), or total artificial heart ([TAH]) device between 2004 and 2012. Unconditional and conditional survivals were compared with the Kaplan-Meier method. Cox proportional hazards regression models were constructed to determine the risk-adjusted influence of support type on death. Results: Of the 4,177 patients identified, 3,457 (20.4%), 575 (3.4%), and 145 (0.9%) were bridged with an LVAD, BiVAD, and TAH, respectively. Unadjusted 30-day, 1-year, and 5-year estimated survival was greater in LVAD patients than in the BiVAD and TAH cohorts. After risk-adjustment, BiVAD and TAH were associated with an increased risk of death at all time points. Unadjusted and adjusted 5-year survival, conditional on 1-year survival, was worse, however, in only TAH patients. Conclusions: Patients with biventricular failure bridged to OHT with a TAH or BiVAD experience worse short- and long-term survival comparison with those with an LVAD. This difference is most likely due to an increase in early death and depends on the type of BiVAD device implanted.

AB - Background: Biventricular support before orthotopic heart transplantation (OHT) has been shown to adversely affect short- and long-term outcomes, but the comparative effect of support type is largely unknown. This study determined the comparative effect of univentricular and biventricular support on survival in bridged patients after OHT. Methods: The United Network of Organ Sharing database was queried for adult patients bridged to OHT with a univentricular (left ventricular assist device [LVAD]), biventricular (biventricular assist device [BiVAD]), or total artificial heart ([TAH]) device between 2004 and 2012. Unconditional and conditional survivals were compared with the Kaplan-Meier method. Cox proportional hazards regression models were constructed to determine the risk-adjusted influence of support type on death. Results: Of the 4,177 patients identified, 3,457 (20.4%), 575 (3.4%), and 145 (0.9%) were bridged with an LVAD, BiVAD, and TAH, respectively. Unadjusted 30-day, 1-year, and 5-year estimated survival was greater in LVAD patients than in the BiVAD and TAH cohorts. After risk-adjustment, BiVAD and TAH were associated with an increased risk of death at all time points. Unadjusted and adjusted 5-year survival, conditional on 1-year survival, was worse, however, in only TAH patients. Conclusions: Patients with biventricular failure bridged to OHT with a TAH or BiVAD experience worse short- and long-term survival comparison with those with an LVAD. This difference is most likely due to an increase in early death and depends on the type of BiVAD device implanted.

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