Implantable Lvad Support Does Not Affect Outcomes After Heart Transplant
Tomaso Bottio, Massimiliano Carrozzini, Antonio Gambino, Giuseppe Toscano, Vincenzo Tarzia, Raphael Caraffa, Olimpia Bifulco, Jonida Bejko, Dario Gregori, Gino Gerosa.
Cardiac Surgery, Padova, Italy.
Background Left-Ventricular-Assist-Devices (LVADs) have been increasingly used as bridge-to-transplant, yet whether their use affects outcomes after HTx is unclear. The aim of the present study was to analyze the post-HTx outcomes of patients with or without previous support with an LVAD. Materials and methods We reviewed all patients who underwent HTx between January-2012 and December-2017. Exclusion criteria were: anatomical/technical contraindications to LVAD and bridge-to-candidacy implant strategy. Outcomes considered were early and mid-term survival and rate of adverse events. Results We included 138 patients: 46 previously implanted with a continuous-flow LVAD (LVAD group) and 92 not (No-LVAD group). LVAD patients were younger and more frequently male. Cardiac risk factors were similarly distributed amongst the two groups. Donor characteristics were similar. Mean time of follow-up was 26±22 months. Kaplan-Meier survival was comparable between groups (log-rank p= 0.67) with 12-month survival of 81% (CI95%: 72% - 89%) in No-LVAD group and 85% in LVAD group (CI95%: 74% - 95%). Thirty-day death was similar (9% LVAD vs 4% No-LVAD, p=0.44), as well as ICU-stay (p=0.05) and hospital-stay (p=0.08). Rates of adverse events were comparable. LVAD patients showed a higher rate of donor specific antibody development (32% vs 12%, p=0.03). Conclusions Post-HTx survival was comparable between patients previously assisted with LVAD or not. Rate of early and mid-term adverse events was similar, as well.