SAN FRANCISCO — Heart transplant recipients who were bridged to transplant with an implantable left ventricular assist device showed similar survival to patients who were treated with inotrope-only support, in a retrospective study.
From 1994 to 2007, 173 status 1 patients received orthotopic heart transplants after inotrope-only (IO) support, and 86 patients received transplants after support with an LVAD used as a bridge to transplant, Dr. Jay D. Pal reported at the annual meeting of the Society of Thoracic Surgeons.
Baseline characteristics were similar between the IO and the LVAD patients at the time of transplant. But prior to LVAD implantation, this group of patients had significantly worse hemodynamics. “During the period of LVAD support, cardiopulmonary status improved to become equivalent to the inotropic-bridged patients,” noted Dr. Pal and his colleagues at Duke University, Durham, N.C.
Survival at 1 year after transplant was similar in both groups (88% in the IO patients vs. 85% in the LVAD group) and at 5 years (76% of IO vs. 73% of LVAD). Infectious complications after transplant were also similar in both groups.
The likelihood of a rejection episode during the first year post transplant was also similar (44% IO vs. 52% LVAD).
“Bridge to transplant with an implantable LVAD device provides comparable outcomes to status 1 patients who were stabilized on inotrope infusion only,” the researchers said. This is despite the fact that patients bridged to transplant with an LVAD represent a subset of patients who deteriorated on maximal medical therapy, according to Dr. Pal, who had no disclosures to report.