Heart transplantation outcomes in patients with continuous-flow left ventricular assist device-related complications

Abstract

Background: Device-related complications (DRC) can develop in patients supported with continuous-flow left ventricular assist devices (CF-LVADs). We studied the heart transplant (HTx) outcomes of United Network of Organ Sharing (UNOS) Status 1A patients supported with CF-LVADs with (+) or without (-) DRCs.

Methods: UNOS data (2006 to 2012) for patients listed under Status 1A with CF-LVADs at the time of HTx were analyzed. Outcomes were compared between the DRC+ and DRC- groups. The DRC+ group was further analyzed under 5 UNOS categories: B1 to B5.

Results: Of the 6,799 patients who received HTx under 1A listing, 2,113 (31%) were supported with CF-LVADs. From 2006 to 2012, patients supported with CF-LVADs under the 1A listing increased from 11.4% to 41.5% (p = 0.0001). The DRC+ group (45%) compared with the DRC- group (55%) had longer waiting times (330 ± 323 days vs 168 ± 298 days), more patients with blood group O (57% vs 40%), and a higher body mass index (29 ± 5.5 kg/m(2) vs 27 ± 5 kg/m(2)). Most of the DRCs were in the B2 category (54%). Post-HTx survival for the DRC+ group was significantly reduced compared with the DRC- group at 1 year (85.6% vs 89.9%, p = 0.01) and at 3 years (78% vs 82.7%, p = 0.01), primarily due to B2 category.

Conclusions: An increasing number of patients receiving HTx under 1A listing are supported with CF-LVADs. DRCs are steadily increasing, with most of them from the B2 category. Post-HTx survival in DRC+ group is inferior, primarily for the B2 category. The benefits of CF-LVADs for patients awaiting HTx need to be weighed against the development of DRCs with subsequently inferior post-HTx survival.

Keywords: United Network of Organ Sharing; continuous-flow; device-related complications; heart transplantation; left ventricular assist device.