Teruhiko Imamura1, Koichiro Kinugawa1, Minoru Ono2, Norihide Fukushima3, Akira Shiose4, Yoshiro Matsui5, Kenji Yamazaki6, Yoshikatsu Saiki7, Goro Matsumiya8, Hirokuni Arai9, Yoshiki Sawa10. 1. Second Department of Internal Medicine, University of Toyama. 2. Department of Cardiac Surgery, The University of Tokyo Hospital. 3. Department of Transplant Medicine, National Cerebral and Cardiovascular Center. 4. Department of Cardiovascular Surgery, Kyushu University. 5. Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine. 6. Department of Cardiovascular Surgery, Tokyo Women's Medical University. 7. Department of Cardiovascular Surgery, Tohoku University. 8. Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine. 9. Department of Cardiovascular Surgery, Tokyo Medical and Dental University. 10. Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine.
Abstract
BACKGROUND: The bridge-to-bridge (BTB) strategy, a conversion to durable left ventricular assist device (LVAD) after stabilization using surgical temporary mechanical circulatory supports for a couple of months, is not uncommon in Japan. However, its effect on clinical outcomes in comparison with a primary durable LVAD implantation strategy remains unknown.Methods and Results: Data of 837 consecutive patients (median age 45, 73% males) who underwent durable LVAD implantation as BTB (n=168) or primary implant (n=669) between April 2011 and April 2019 were retrospectively reviewed from the prospective multicenter Japanese mechanically assisted circulatory support registry. The BTB group was younger and had comparable end-organ function, better hemodynamic profile, and longer operative time compared with the primary implant group at baseline. The 3-year survival was 80% vs. 87% (P=0.007) for the BTB and primary implant groups respectively, with greater observed rates of stroke and infection as the predominant causes of death. The BTB strategy was independently associated with increased 3-year mortality (hazard ratio 2.69 [1.43-5.07], P=0.002) in addition to other significant risk factors. CONCLUSIONS: The BTB cohort had comparable baseline characteristics to the primary implant cohort at the time of durable LVAD conversion, but had lower 3-year survival. Detailed analysis clarifying the causality of this finding should improve outcomes with the BTB strategy.
BACKGROUND: The bridge-to-bridge (BTB) strategy, a conversion to durable left ventricular assist device (LVAD) after stabilization using surgical temporary mechanical circulatory supports for a couple of months, is not uncommon in Japan. However, its effect on clinical outcomes in comparison with a primary durable LVAD implantation strategy remains unknown.Methods and Results: Data of 837 consecutive patients (median age 45, 73% males) who underwent durable LVAD implantation as BTB (n=168) or primary implant (n=669) between April 2011 and April 2019 were retrospectively reviewed from the prospective multicenter Japanese mechanically assisted circulatory support registry. The BTB group was younger and had comparable end-organ function, better hemodynamic profile, and longer operative time compared with the primary implant group at baseline. The 3-year survival was 80% vs. 87% (P=0.007) for the BTB and primary implant groups respectively, with greater observed rates of stroke and infection as the predominant causes of death. The BTB strategy was independently associated with increased 3-year mortality (hazard ratio 2.69 [1.43-5.07], P=0.002) in addition to other significant risk factors. CONCLUSIONS: The BTB cohort had comparable baseline characteristics to the primary implant cohort at the time of durable LVAD conversion, but had lower 3-year survival. Detailed analysis clarifying the causality of this finding should improve outcomes with the BTB strategy.
Entities:
Keywords:
Heart failure; Hemodynamics; Japanese registry for Mechanical Assisted Circulatory Support (J-MACS); Stroke