CORRESPONDENCE: LETTER TO THE EDITOR
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Vishnu Patlolla, MD,
Richard D. Patten, MD,
David DeNofrio, MD,
Marvin A. Konstam, MD and
Rajan Krishnamani, MD*
* Division of Cardiology, Tufts Medical Center, 800 Washington Street, Box 5931 Boston, Massachusetts 02111 (Email: rkrishnamani{at}tuftsmedicalcenter.org).
We would like to thank Dr. Sindermann and colleagues for their interest in our paper (1). The decision to proceed with ventricular assist device (VAD) implantation in patients awaiting heart transplantation is complex. The factors that influence this decision for a given patient include his or her anticipated rate of clinical decline, estimated time to availability of a donor organ, and expected survival in the absence of mechanical circulatory support. Variations in organ allocation policies between different countries also may influence decisions regarding timing of VAD implantation and may lead to different outcomes after heart transplantation. Since our analysis is based on a U.S. patient population, the explanations for our findings are best drawn from practice patterns in the U.S. rather than in Europe.
In our analysis of United Network for Organ Sharing registry data, we were not able to demonstrate an improvement in post-transplant survival for patients bridged with a VAD. Our data, therefore, do not support the routine use of VAD therapy for stable United Network for Organ Sharing status 1 patients with the primary goal of improving post-transplant survival. At our institution, we limit the use of VADs as a bridge to transplant for patients who exhibit refractory symptoms and/or evidence of hemodynamic compromise despite the use of intravenous inotropic/vasodilator therapy.
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1. Patlolla V, Patten RD, DeNofrio D, Konstam MA, Krishnamani R. The effect of ventricular assist devices on post-transplant mortality: an analysis of the United Network for Organ Sharing Thoracic Registry J Am Coll Cardiol 2009;53:264-271.[Abstract/Free Full Text]
Related Article
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Impact of Ventricular Assist Device Support on Post-Transplant Mortality: Searching for Reasons
- Jürgen R. Sindermann, Christian Vahlhaus, Andreas Hoffmeier, Hans H. Scheld, and Stefan Klotz
J. Am. Coll. Cardiol. 2009 54: 573.
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