CLINICAL STUDY: HEART FAILURE
Left ventricular assist device therapy improves utilization of donor hearts
Keith D. Aaronson, MD, MS*,
Michael J. Eppinger, MD ,
David B. Dyke, MD*,
Susan Wright, BS, RN and
Francis D. Pagani, MD, PhD, FACC,*
* Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA
Section of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
Manuscript received July 26, 2001;
revised manuscript received November 5, 2001,
accepted January 30, 2002.
* Reprint requests and correspondence: Dr. Francis D. Pagani, Section of Cardiac Surgery, 2120 Taubman Center, Box 0348, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109, USA.
fpagani{at}umich.edu
OBJECTIVES: We sought to determine the survival experiences of patients bridged to heart transplantation with either intravenous (IV) inotropes or an implantable left ventricular assist device (LVAD).
BACKGROUND: Because of the operative risks of LVAD implantation and the reported lower mortality associated with inotropic therapy, bridging to heart transplantation with inotropes is thought to be the preferred treatment option.
METHODS: Between April 1, 1996, and May 10, 2001, a total of 104 patients were bridged to heart transplantation with either IV inotropes (n = 38) or an implantable LVAD (n = 66; HeartMate). Survival was compared (Kaplan-Meier method) for three periods: survival to transplantation, post-transplantation survival and overall survival (i.e., survival from the onset of bridging to follow-up).
RESULTS: Survival to transplantation was 81 ± 5% at three months for the LVAD group and 64 ± 11% for the inotrope group (p = NS). Post-transplantation survival was 95 ± 4% at three years for the LVAD group (two deaths) and 65 ± 10% at three years for the inotrope group (nine deaths; p = 0.007). Overall survival was 77 ± 6% at three years for the LVAD group and 44 ± 9% at three years for the inotrope group (p = 0.01).
CONCLUSIONS: Overall survival for patients who were bridged to heart transplantation with an implantable LVAD was superior to that of patients who were bridged with inotropes. Bridging to transplantation with an implantable LVAD improves utilization of donor hearts.
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Abbreviations and Acronyms
| | ECMO | | extracorporeal membrane oxygenation | | IV | | intravenous | | LVAD | | left ventricular assist device | | UNOS | | United Network for Organ Sharing | | VAD | | ventricular assist device | | VSD | | ventricular septal defect |
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