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One hundred days or more bridged on a ventricular assist device and effects on outcomes following heart transplantation

^a Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, United States
^b Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
^c Department of Pharmacy, Cleveland Clinic, Cleveland, OH, United States

Received 4 December 2007; received in revised form 20 April 2008; accepted 23 April 2008.

^_* Corresponding author. Address: Department of Thoracic and Cardiovascular Surgery/F24, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States. Tel.: +1 216 444 6708; fax: +1 216 445 3294. (Email: gonzalg{at}ccf.org).

Background: Successful bridging to transplantation (BTT) with ventricular assist devices (VAD) is an alternative to mitigate the effects of end-stage heart failure on organ function while awaiting a heart. The effects of long-term VAD BTT on patient outcomes following transplantation are poorly studied. Methods: A retrospective chart review identified 145 patients BTT with a VAD between November of 1996 and June of 2005 at the Cleveland Clinic. Patients were divided into two groups and outcomes were compared: group 1 was supported for <100 days (median = 44 days) and group 2 was supported for 100 days (median = 161 days). Results: Patients in group 1 were less likely to be blood type O (33% vs 68%, p < 0.0001). BTT <100 days trended towards independently predicting improved survival by multivariate proportional hazards analysis (risk ratio = 0.75, 95% CI = 0.52–1.08, p = 0.12), largely due to reduced in-hospital mortality in this group (2% vs 11%, p = 0.055); however, no significant difference with respect to long-term survival was observed by Kaplan–Meier analysis (p = 0.14). Furthermore, causes of death differed between groups: group 1 more commonly died of coronary artery vasculopathy (26% vs 0%, p = 0.022) and group 2 more commonly died of sepsis (60% vs 26%, p = 0.026). Ultimately, 21% of all group 2 patients died from sepsis (compared to 7% of group 1 patients, p = 0.018). Conclusions: This study suggests that prolonged BTT with a VAD is a viable treatment strategy but may lead to significantly more post-transplant deaths from sepsis and higher in-hospital mortality. These data may inform management of this high-risk patient population.

Key Words: Ventricular assist device • Transplant • Survival • Sepsis