Long-term outcome of heart transplantation performed after ventricular assist device compared with standard heart transplantation

Abstract

Background: Data on the long-term outcome of heart transplantation in patients with a ventricular assist device (VAD) are scarce.

Aim: To evaluate long-term outcome after heart transplantation in patients with a VAD compared with no mechanical circulatory support.

Methods: Consecutive all-comers who underwent heart transplantation were included at a single high-volume centre from January 2005 until December 2012, with 5 years of follow-up. Clinical and biological characteristics, operative results, outcomes and survival were recorded. Regression analyses were performed to determine predictors of 1-year and 5-year mortality.

Results: Fifty-two patients with bridge to transplantation by VAD (VAD group) and 289 patients transplanted without a VAD (standard group) were enrolled. The mean age was 46±11 years in the VAD group compared with 51±13 years in the standard group (P=0.01); 17% of the VAD group and 25% of the standard group were women (P=0.21). Ischaemic time was longer in the VAD group (207±54 vs 169±60minutes; P<0.01). There was no difference in primary graft failure (33% vs 25%; P=0.22) or 1-year mortality (17% vs 28%; P=0.12). In the multivariable analysis, preoperative VAD was an independent protective factor for 1-year mortality (odds ratio 0.40, 95% confidence interval 0.17-0.97; P=0.04). Independent risk factors for 1-year mortality were recipient age>60 years, recipient creatinine, body surface area mismatch and ischaemic time. The VAD and standard groups had similar long-term survival, with 5-year mortality rates of 35% and 40%, respectively (P=0.72).

Conclusions: Bridge to transplantation by VAD was associated with a reduction in 1-year mortality, leading critically ill patients to similar long-term survival compared with patients who underwent standard heart transplantation. This alternative strategy may benefit carefully selected patients.

Keywords: Advanced heart failure therapies; Cardiaque; Heart failure; Heart failure with reduced ejection fraction; Heart transplantation; Insuffisance cardiaque; Insuffisance cardiaque à fraction d’éjection altérée; Left ventricular assist device; Traitements de l’insuffisance cardiaque avancée (dispositifs d’assistance; Transplantation; Ventriculaire gauche, Cœur artificiel total).