Ann Cardiovasc Surg | Volume 1, Issue 2 | Case Report | Open Access
Ann C Gaffey, Carol W Chen, Jennifer J Chung, Joyce Wald and Pavan Atluri*
Department of Cardiovascular Surgery, University of Pennsylvania, USA
*Correspondance to: Pavan Atluri
Fulltext PDFIntroduction: Outcomes in patients undergoing Ventricular Assist Device (VAD) implant continue to improve with excellent long-term survival and improving adverse event profiles. However, skepticism remains in transplanting elderly patients from VADs implanted as bridge to transplant, given concern over the complexity of the operation and post-operative recovery. We hypothesized that elderly (65 years of age and older) patients on VAD support could successfully be transplanted with minimal morbidity and mortality.
Methods: We retrospectively analyzed the UNOS adult heart transplant donor and recipient data from June 2004 to December 2013, during which 6,793 Orthotopic Heart Transplants (OHT) were performed in patients older than 65 years of age. The recipients were divided into two cohorts: BTT with continuous flow LVAD (n=329) or non-VAD (n=6,265). Patients with an RVAD, total heart, biventricular assist device, or multi-organ transplant were excluded (n=199). Statistical analyses included descriptive statistics and Kaplan-Meier survival analyses.
Results: No differences existed with regard to recipient gender (p=0.14), total waitlist time (p=0.14), history of chronic obstructive pulmonary disease (p=0.07), or prior transfusions (p=0.36). Donors did not differ with regards to age (p=0.09), gender (p=0.11) or left ventricular ejection fraction (p=0.59). The BTT recipients’ allografts had a significantly longer ischemic time (p=0.02). Postoperatively, there was a significantly higher incidence of dialysis within the non-VAD cohort (9.7%) compared to BTT cohort (6.3%, p=0.04). The incidence of cardiac re-operation (p=0.32), stroke (p=0.34), infection (p=0.11) and heart block (p=0.31) were similar. The rate of rejection was low without significant differences amongst the cohorts (8.7% vs. 6.1%, p=0.07). There was no difference in length of hospital stay (p=0.11). One (90% vs. 85%) and five-year (69% vs. 71%) survival was similar in the BTT and non-VAD cohorts, using Kaplan-Meier Survival Analysis (log rank p=0.1090).
Conclusion: Appropriately selected patients ≥ 65 years of age, bridged with an LVAD have a survival comparable to those patients without an LVAD, post-orthotopic heart transplant. The benefits of VAD as BTT should be considered in patients 65 and older to allow stabilization for subsequent OHT.
Heart transplant; Left ventricular assist device; Bridge to transplantation
Gaffey AC, Chen CW, Chung JJ, Wald J, Atluri P. Elderly Patients Bridged from Left Ventricular Assist Devices to Heart Transplant are not at Increased Risk. Ann Cardiovasc Surg. 2018; 1(2): 1010.