• J. Heart Lung Transplant. · Feb 2016

    Multicenter Study Comparative Study

    Right ventricular assist device results in worse post-transplant survival.

    • Sharven Taghavi, Senthil N Jayarajan, Eugene Komaroff, and Abeel A Mangi.
    • Department of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
    • J. Heart Lung Transplant. 2016 Feb 1; 35 (2): 236-41.

    BackgroundTo our knowledge, how the need for a right ventricular assist device (RVAD) with a left ventricular assist device (LVAD) affects outcomes after orthotopic heart transplantation has not been studied in a multi-institutional database.MethodsThe United Network for Organ Sharing (UNOS) database was queried for all adult orthotopic heart transplantations from the period 2005-2012. Patients requiring a RVAD + LVAD as a bridge to transplant were compared with patients requiring a LVAD only and patients requiring no ventricular assist device (VAD).ResultsDuring the study period, 16,955 orthotopic heart transplantations were performed. Of these, 13,209 (77.9%) patients did not require a VAD, 3,270 (19.3%) required a LVAD only, and 457 (2.7%) required a RVAD + LVAD. The RVAD + LVAD group had the longest length of stay (25.7 days) compared with the no VAD group (20.8 days) and the LVAD-only group (21.1 days) (p < 0.001). On multivariate analysis, requirement of a RVAD + LVAD before transplantation was independently associated with post-transplant mortality (hazard ratio 1.22, 95% confidence interval 1.01-1.49, p = 0.04). Other variables associated with mortality included donor age, pulsatile flow LVAD as a bridge to transplant, prolonged ischemic time, worsening renal function, black race, history of diabetes in recipient, class II panel-reactive antibody >10%, sex mismatch, and extracorporeal membrane oxygenation or mechanical ventilation as a bridge to transplant.ConclusionsThe requirement of a RVAD in addition to a LVAD before orthotopic heart transplantation is associated with worse post-transplant outcomes and increased mortality.Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

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