The Journal of thoracic and cardiovascular surgery · 2025
Outcomes among patients bridged to heart transplant with microaxial flow versus durable left ventricular assist device support.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Alvarez Alejandro, Dewan Krish C, Milano Carmelo A, Jawitz Oliver K, Benkert Abigail R, Olive Jacqueline K, Berryan Allison, Peralta Isabella, Patel Chetan B, Agarwal Richa, DeVore Adam D, McCartney Sharon, Schroder Jacob N, Keenan Jeffrey E
Аннотация
OBJECTIVE: To evaluate characteristics and outcomes of patients bridged to orthotopic heart transplantation with microaxial left ventricular assist device (ma-LVAD) versus durable LVAD (d-LVAD).
METHODS: This was a single-center retrospective cohort study in which characteristics outcomes of patients undergoing orthotopic heart transplantation between May 2019 and May 2024 who were bridged with ma-LVAD versus d-LVAD, were compared.
RESULTS: Over the study period, the percentage of patients bridged with ma-LVAD increased from 0% to 20%. Patients bridged with d-LVAD were more likely to have history of hypertension (80% vs 65%; P = .03), a higher body mass index (32.53 vs 28.15; P < .0001), and anti-human leukocyte antigens antibodies (54% vs 36%; P = .02) before transplant, otherwise groups were similar in their baseline characteristics. Unadjusted Kaplan-Meier analysis demonstrated no difference in survival between these 2 bridging strategies. However, postoperative blood product use (3 vs 0 units; P < .0001), moderate or severe primary graft dysfunction (27% vs 14%; P = .04), and delayed sternal closure (45% vs 9%; P < .0001) were all higher among those bridged with d-LVAD versus ma-LVAD. Rejection on the first postoperative biopsy was reported in a 60% in the d-LVAD group versus 33% in the ma-LVAD group (P = .0006). Postoperative intensive care unit (7 vs 6 days; P = .03) and overall postoperative length of stay (17 vs 12 days; P = .002) were greater in patients bridged with d-LVAD versus ma-LVAD, respectively.
CONCLUSIONS: The use of ma-LVAD compared with d-LVAD as a bridging strategy was not associated with differences in survival. However, bridging with ma-LVAD compared with d-LVAD was associated with lower morbidity after orthotopic heart transplantation.
METHODS: This was a single-center retrospective cohort study in which characteristics outcomes of patients undergoing orthotopic heart transplantation between May 2019 and May 2024 who were bridged with ma-LVAD versus d-LVAD, were compared.
RESULTS: Over the study period, the percentage of patients bridged with ma-LVAD increased from 0% to 20%. Patients bridged with d-LVAD were more likely to have history of hypertension (80% vs 65%; P = .03), a higher body mass index (32.53 vs 28.15; P < .0001), and anti-human leukocyte antigens antibodies (54% vs 36%; P = .02) before transplant, otherwise groups were similar in their baseline characteristics. Unadjusted Kaplan-Meier analysis demonstrated no difference in survival between these 2 bridging strategies. However, postoperative blood product use (3 vs 0 units; P < .0001), moderate or severe primary graft dysfunction (27% vs 14%; P = .04), and delayed sternal closure (45% vs 9%; P < .0001) were all higher among those bridged with d-LVAD versus ma-LVAD. Rejection on the first postoperative biopsy was reported in a 60% in the d-LVAD group versus 33% in the ma-LVAD group (P = .0006). Postoperative intensive care unit (7 vs 6 days; P = .03) and overall postoperative length of stay (17 vs 12 days; P = .002) were greater in patients bridged with d-LVAD versus ma-LVAD, respectively.
CONCLUSIONS: The use of ma-LVAD compared with d-LVAD as a bridging strategy was not associated with differences in survival. However, bridging with ma-LVAD compared with d-LVAD was associated with lower morbidity after orthotopic heart transplantation.