Omar Wever-Pinzon1, Yoshifumi Naka2, Arthur R Garan3, Koji Takeda2, Stephen Pan4, Hiroo Takayama2, Donna M Mancini5, Paolo Colombo3, Veli K Topkara3. 1. Division of Cardiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah. Electronic address: omar.wever.pinzon@hsc.utah.edu. 2. Division of Cardiothoracic Surgery, Department of Surgery and. 3. Division of Cardiology, Department of Medicine. New York Presbyterian Hospital-Columbia University Medical Center, New York, New York. 4. Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, New York. 5. Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Abstract
BACKGROUND: This study evaluated current trends in incidence and outcomes of left ventricular assist device (LVAD)-related thromboembolic (LVAD-TE) and LVAD malfunction (LVAD-M) complications among heart transplant (HT) candidates supported with continuous-flow LVADs. LVAD-TE and LVAD-M are potentially catastrophic complications that may require status upgrade on the HT waiting list. An increased incidence of device thrombosis has been recently observed; however, whether similar trends of LVAD-TE and LVAD-M are observed on the HT waiting list and their effect on outcomes is unknown. METHODS: We analyzed 3,821 HT candidates on continuous-flow LVADs who were registered on the United States waiting list from 2008 to 2014. We evaluated the incidence of LVAD-TE and LVAD-M as well as survival before and after HT. RESULTS: LVAD-TE occurred in 249 patients (6.5%) and LVAD-M in 210 patients (5.5%). The incidence of LVAD-TE was highest in regions 1, 2, and 9, whereas LVAD-M was highest in regions 9, 1, and 7. The incidence of LVAD-TE and LVAD-M increased after 2011 from 0.04 to 0.10 and from 0.03 to 0.08 events per patient-year (p < 0.0001 for both comparisons). Survival on the waiting list at 2 years was lower in candidates with LVAD-TE (45% vs 72%, p < 0.0001) and LVAD-M (56% vs 71%, p = 0.003) compared with candidates without complications. Post-HT survival was similar between patients with and without LVAD-TE and LVAD-M (p > 0.43 for both outcomes). In patients with LVAD-TE, mortality risk was highest among candidates managed conservatively (hazard ratio, 8.07; p < 0.0001), whereas patients who underwent HT only (hazard ratio, 0.10; p < 0.0001) had the lowest mortality risk and similar to that of patients without LVAD-TE (p = 0.34). CONCLUSIONS: The incidence of LVAD-TE and LVAD-M on the United States waiting list has increased since 2011, with significant regional variation. LVAD-TE and LVAD-M have a detrimental effect on waiting list survival and transplant candidacy. In candidates who develop an LVAD-TE, a conservative approach, without LVAD exchange or HT, carries the highest risk of death. These results should be considered in the ongoing efforts to optimize the allocation of donor hearts. Published by Elsevier Inc.
BACKGROUND: This study evaluated current trends in incidence and outcomes of left ventricular assist device (LVAD)-related thromboembolic (LVAD-TE) and LVAD malfunction (LVAD-M) complications among heart transplant (HT) candidates supported with continuous-flow LVADs. LVAD-TE and LVAD-M are potentially catastrophic complications that may require status upgrade on the HT waiting list. An increased incidence of device thrombosis has been recently observed; however, whether similar trends of LVAD-TE and LVAD-M are observed on the HT waiting list and their effect on outcomes is unknown. METHODS: We analyzed 3,821 HT candidates on continuous-flow LVADs who were registered on the United States waiting list from 2008 to 2014. We evaluated the incidence of LVAD-TE and LVAD-M as well as survival before and after HT. RESULTS:LVAD-TE occurred in 249 patients (6.5%) and LVAD-M in 210 patients (5.5%). The incidence of LVAD-TE was highest in regions 1, 2, and 9, whereas LVAD-M was highest in regions 9, 1, and 7. The incidence of LVAD-TE and LVAD-M increased after 2011 from 0.04 to 0.10 and from 0.03 to 0.08 events per patient-year (p < 0.0001 for both comparisons). Survival on the waiting list at 2 years was lower in candidates with LVAD-TE (45% vs 72%, p < 0.0001) and LVAD-M (56% vs 71%, p = 0.003) compared with candidates without complications. Post-HT survival was similar between patients with and without LVAD-TE and LVAD-M (p > 0.43 for both outcomes). In patients with LVAD-TE, mortality risk was highest among candidates managed conservatively (hazard ratio, 8.07; p < 0.0001), whereas patients who underwent HT only (hazard ratio, 0.10; p < 0.0001) had the lowest mortality risk and similar to that of patients without LVAD-TE (p = 0.34). CONCLUSIONS: The incidence of LVAD-TE and LVAD-M on the United States waiting list has increased since 2011, with significant regional variation. LVAD-TE and LVAD-M have a detrimental effect on waiting list survival and transplant candidacy. In candidates who develop an LVAD-TE, a conservative approach, without LVAD exchange or HT, carries the highest risk of death. These results should be considered in the ongoing efforts to optimize the allocation of donor hearts. Published by Elsevier Inc.
Authors: Muhammad Shahreyar; Tamunoinemi Bob-Manuel; Rami N Khouzam; Mohammad W Bashir; Samian Sulaiman; Oluwaseun Akinseye; Arindam Sharma; April Carter; Samuel Latham; Sanjay Bhandari; Arshad Jahangir Journal: Ann Transl Med Date: 2018-01