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Results of new-generation intrapericardial continuous flow left ventricular assist devices as a bridge-to-transplant

Carrozzini, Massimilianoa; Bejko, Jonidaa; Gambino, Antonioa; Tarzia, Vincenzoa; Lanera, Corradob; Gregori, Dariob; Gerosa, Ginoa; Bottio, Tomasoa

Journal of Cardiovascular Medicine: December 2018 - Volume 19 - Issue 12 - p 739–747
doi: 10.2459/JCM.0000000000000721
Research articles: Cardiac surgery

Aims We analysed the outcomes with the use of a new-generation continuous-flow left ventricular assist device (CF-LVAD) as a bridge-to-transplant (BTT).

Materials and methods We included all patients implanted with an intrapericardial CF-LVAD as BTT, between January 2012 and December 2016. Primary outcomes were overall survival, survival on waiting list and postheart transplant (HTx) survival. The outcomes after HTx were compared with those of a contemporary cohort of patients transplanted without previous CF-LVAD (No-LVAD group, n = 73).

Results We included 53 patients with a median age of 52 years (interquartile range: 43–59 years). Seventy-two percent were in INTERMACS profile 1–2 before implant; all entered the HTx waiting list after receiving the CF-LVAD. HTx was performed in 42 (79%) cases (LVAD group). Overall estimated survival (considering both pre-HTx and post-HTx) was 89% [95% confidence interval (CI) 81–98%] at 1 year and 80% (CI 70–92%) at 2 years. The estimated survival on waiting list was 91% (CI 80–100%) at 6 months, whereas the 1-year estimated post-HTx survival was 88% (CI 79–98%). The Kaplan–Meier curves of survival after HTx of LVAD versus No-LVAD group were comparable (log-rank P = 0.54), as well as the rates of post-HTx adverse events. A multivariable model of survival after HTx, accounting for the most relevant patient characteristics, identified LVAD use as a significant protective factor [LVAD versus No-LVAD hazard ratio 0.22 (CI 0.06–0.91)].

Conclusion The use of new-generation intrapericardial CF-LVADs as a BTT resulted, in our series, in satisfactory pre-HTx and post-HTx outcomes.

aCardiac Surgery Unit

bUnit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy

Correspondence to Massimiliano Carrozzini, MD, U.O.C. Cardiochirurgia, Policlinico Universitario, Via Giustiniani 2, 35128 Padova, Italy Tel: +39 49 8212410; fax: +39 49 8212409; e-mail: massimiliano.carrozzini@gmail.com

Received 5 April, 2018

Accepted 13 September, 2018

© 2018 Italian Federation of Cardiology. All rights reserved.