1
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Weingarten N, Iyengar A, Herbst DA, Helmers M, Meldrum D, Guevara-Plunkett S, Dominic J, Atluri P. Extended criteria donor organ use for heart-lung transplantation in the modern era. Clinics (Sao Paulo) 2023; 78:100205. [PMID: 37120982 PMCID: PMC10172855 DOI: 10.1016/j.clinsp.2023.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Demand for donor hearts and lungs exceeds their supply. Extended Criteria Donor (ECD) organs are used to help meet this demand, but their impact on heart-lung transplantation outcomes is poorly characterized. METHODS AND RESULTS The United Network for Organ Sharing was queried for data on adult heart-lung transplantation recipients (n = 447) from 2005‒2021. Recipients were stratified based on whether they received ECD hearts and/or lungs. Morbidity was analyzed using Kruskal-Wallis, chi-square, and Fisher's exact tests. Mortality was analyzed using Kaplan-Meier estimation, log-rank tests and Cox regression. Sixty-five (14.5%) patients received two ECD organs, 134 (30.0%) received only an ECD lung, and 65 (14.5%) only an ECD heart. Recipients of two ECD organs were older, more likely to have diabetes, and more likely transplanted from 2015‒2021 (p < 0.05). Groups did not differ by pre-transplant diagnosis, intensive care unit disposition, life support use, or hemodynamics. Group five-year survival rates ranged from 54.5% to 63.2% (p = 0.428). Groups did not differ by 30-day mortality, strokes, graft rejection, or hospital length of stay. CONCLUSIONS Using ECD hearts and/or lungs for heart-lung transplantation is not associated with increased mortality and is a safe strategy for increasing donor organ supply in this complex patient population.
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Affiliation(s)
- Noah Weingarten
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, USA
| | - Amit Iyengar
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, USA
| | - David Alan Herbst
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, USA
| | - Mark Helmers
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, USA
| | - Danika Meldrum
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, USA
| | - Sara Guevara-Plunkett
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, USA
| | - Jessica Dominic
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, USA
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, USA.
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2
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Kainuma A, Ning Y, Kurlansky PA, Wang AS, Latif F, Sayer GT, Uriel N, Kaku Y, Naka Y, Takeda K. Predictors of one-year outcome after cardiac re-transplantation: Machine learning analysis. Clin Transplant 2022; 36:e14761. [PMID: 35730923 DOI: 10.1111/ctr.14761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/02/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND As cardiac re-transplantation is associated with inferior outcomes compared with primary transplantation, allocating scarce resources to appropriate re-transplant candidates is important. The aim of this study is to elucidate the factors associated with 1-year mortality in cardiac re-transplantation using the random forests algorithm for survival analysis. METHODS We retrospectively reviewed the United Network for Organ Sharing registry and identified all adult (>17 years old) recipients who underwent cardiac re-transplantation between January 2000 and March 2020. The random forest algorithm on Cox modeling was used to calculate the variable importance (VIMP) of independent variables for contributing to one-year mortality. RESULTS A total of 1294 patients underwent cardiac re-transplantation. Of these, 137 patients were re-transplanted within one year of their first transplant, while 1157 patients were re-transplanted more than one year after their first transplant. One-year mortality was significantly higher for patients receiving early transplantation compared with those receiving late transplantation (Early 40.6% vs. Late 13.6%, log-rank P<0.001). Machine learning analysis showed that total bilirubin (>2 mg/dl) (VIMP, 2.99%) was an independent predictor of one-year mortality after early re-transplant. High BMI (>30.0 kg/m2) (VIMP, 1.43%) and ventilator dependence (VIMP, 1.47%) were independent predictors of one-year mortality for the late re-transplantation group. CONCLUSION Machine learning showed that optimal one-year survival following cardiac re-transplantation was significantly related to liver function in early re-transplantation, and to obesity and preoperative ventilator dependence in late re-transplantation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Atsushi Kainuma
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Yuming Ning
- Center for Innovation and Outcomes Research, Columbia University, New York, NY, USA
| | - Paul A Kurlansky
- Center for Innovation and Outcomes Research, Columbia University, New York, NY, USA.,Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Amy S Wang
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Farhana Latif
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Gabriel T Sayer
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Nir Uriel
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Yuji Kaku
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
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3
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Antonides CFJ, Yalcin YC, Veen KM, Muslem R, De By TMMH, Bogers AJJC, Gustafsson F, Caliskan K. OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 61:1164-1175. [PMID: 35076057 PMCID: PMC9070499 DOI: 10.1093/ejcts/ezac023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/06/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Christiaan F J Antonides
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Yunus C Yalcin
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Rahatullah Muslem
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Theo M M H De By
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- European Association for Cardio-Thoracic Surgery, EUROMACS, Windsor, UK
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Kadir Caliskan
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
- Corresponding author. Department of Cardiology, Erasmus University Medical Center, Room Rg-431, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands. Tel: +31-681268158; e-mail: (K. Caliskan)
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4
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Han J, Moayedi Y, Yang W, Henricksen EJ, Lee R, Purewal S, Chang E, Duclos S, Lyapin A, Feng K, Hiesinger W, Teuteberg JJ, Khush KK. Impact of using higher-risk donor hearts for candidates with pre-transplant mechanical circulatory support. J Heart Lung Transplant 2021; 41:237-243. [PMID: 34815161 DOI: 10.1016/j.healun.2021.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/02/2021] [Accepted: 09/29/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND We evaluated post-heart transplant (HTx) outcomes after use of higher-risk donor hearts for candidates supported with pre-HTx mechanical circulatory support (MCS). METHODS In this retrospective analysis of the national United Network for Organ Sharing registry, a total of 9,915 adult candidates on MCS underwent HTx from January 1, 2010 to March 31, 2019. Multi-organ, re-transplant, and congenital heart disease patients were excluded. Higher-risk donor organs met at least one of the following criteria: left ventricular ejection fraction <50%, donor to recipient predicted heart mass ratio <0.86, donor age >55 years, or ischemic time >4 hours. Primary outcome was 1 year post-transplant survival. RESULTS Among HTx recipients, 3688 (37.2%) received higher-risk donor hearts. Candidates supported with pre-HTx extracorporeal membrane oxygenation or biventricular assist device (n = 374, 3.8%) who received higher-risk donor hearts had comparable 1 year survival (HR: 1.14, 95% CI: [0.67-1.93], p = 0.64) to recipients of standard-risk donor hearts, when adjusted for recipient age and sex. In candidates supported with intra-aortic balloon pump (n = 1391, 14.6%), transplantation of higher-risk donor hearts did not adversely affect 1 year survival (HR: 0.80, 95% CI: [0.52-1.22], p = 0.30). Patients on durable left ventricular assist devices (LVAD) who received higher-risk donor hearts had comparable 1 year survival to continued LVAD support on the waitlist, but mortality was increased compared to those who received standard-risk donor hearts (HR: 1.37, 95% CI: [1.11-1.70], p = 0.004). CONCLUSIONS Patients requiring pre-HTx temporary MCS who received higher-risk donor hearts had comparable 1 year post-transplant survival to those who received standard-risk donor hearts. Stable patients on durable LVADs may benefit from waiting for standard-risk donor hearts.
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Affiliation(s)
- Jiho Han
- Department of Medicine, Stanford University, Stanford, California
| | - Yasbanoo Moayedi
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Wenjia Yang
- Department of Medicine, Stanford University, Stanford, California
| | | | - Roy Lee
- Department of Pharmacy, Stanford Health Care, Stanford, California
| | - Saira Purewal
- Department of Medicine, Stanford University, Stanford, California
| | | | | | | | - Kent Feng
- Department of Medicine, Stanford University, Stanford, California
| | - William Hiesinger
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Jeffrey J Teuteberg
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California.
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5
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Sugimura Y, Immohr MB, Aubin H, Mehdiani A, Rellecke P, Tudorache I, Lichtenberg A, Boeken U, Akhyari P. Impact of Reported Donor Ejection Fraction on Outcome after Heart Transplantation. Thorac Cardiovasc Surg 2021; 69:490-496. [PMID: 33862635 DOI: 10.1055/s-0041-1725179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The global shortage of donor organs has urged transplanting units to extend donor selection criteria, for example, impaired left ventricular function (LVF), leading to the use of marginal donor hearts. We retrospectively analyzed our patients after orthotopic heart transplantation (oHTX) with a focus on the clinical outcome depending on donor LVF. METHODS Donor reports, intraoperative, echocardiographic, and clinical follow-up data of patients undergoing oHTX at a single-center between September 2010 and June 2020 were retrospectively analyzed. Recipients were divided into two groups based on donor left ventricular ejection fraction (dLVEF): impaired dLVEF (group I; dLVEF ≤ 50%; n = 23) and normal dLVEF group (group N; dLVEF > 50%; n = 137). RESULTS There was no difference in 30-day, 90-day, and 1-year survival. However, the duration of in-hospital stay was statistically longer in group I than in group N (N: 40.9 ± 28.3 days vs. I: 55.9 ± 39.4 days, p < 0.05). Furthermore, postoperative infection events were significantly more frequent in group I (p = 0.03), which was also supported by multivariate analysis (p = 0.03; odds ratio: 2.96; confidence interval: 1.12-7.83). Upon correlation analysis, dLVEF and recipient LVEF prove as statistically independent (r = 0.12, p = 0.17). CONCLUSIONS Impaired dLVEF is associated with prolonged posttransplant recovery and slightly increased morbidity but has no significant impact on survival up to 1 year posttransplant.
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Affiliation(s)
- Yukiharu Sugimura
- Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
| | | | - Hug Aubin
- Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
| | - Arash Mehdiani
- Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
| | - Philipp Rellecke
- Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, University Hospital, Duesseldorf, Germany
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6
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Zhang B, Guo S, Ning J, Li Y, Liu Z. Continuous-flow left ventricular assist device versus orthotopic heart transplantation in adults with heart failure: a systematic review and meta-analysis. Ann Cardiothorac Surg 2021; 10:209-220. [PMID: 33842215 DOI: 10.21037/acs-2020-cfmcs-fs-197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Due to the lack of donor hearts, many studies have assessed the prognosis of heart failure (HF) patients treated with a continuous-flow left ventricular assist device (CF-LVAD). However, previous results have not been consistent and minimal data is available regarding long-term outcomes. There is no consensus on whether CF-LVAD as a bridge or destination therapy (DT) can equal orthotopic heart transplantation (HTx). The purpose of our study is to compare clinical outcomes between CF-LVAD and HTx in adults. Methods We searched controlled trials from PubMed, Cochrane Library, and Embase databases until July 1, 2020. The mortality at different time points and adverse events were analyzed among 12 included studies. Results No significant differences were found in mortality at one-year [odds ratio (OR) =1.08; 95% CI: 0.97-1.21], two-year (OR =1.01; 95% CI: 0.91-1.12), three-year (OR =1.02; 95% CI: 0.69-1.51), and five-year (OR =1.02; 95% CI: 0.93-1.11), as well as the comparison of stroke, bleeding, and infection between CF-LVAD as a bridge versus HTx. The pooled analysis of one-year mortality (OR =2.76; 95% CI: 0.38-20.18) and two-year mortality (OR =1.64; 95% CI: 0.22-12.23) revealed no significant difference between CF-LVAD DT and HTx. Comparisons of adverse events showed no differences in bleeding or infection, but a higher risk of stroke (OR =5.09; 95% CI: 1.74-14.84) for patients treated with CF-LVAD DT than with HTx. Conclusions CF-LVAD as a bridge results in similar outcomes as HTx within five years. CF-LVAD as a DT is associated with similar one-year and two-year mortality, but carries a higher risk of stroke, as compared with HTx.
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Affiliation(s)
- Bufan Zhang
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China
| | - Shaohua Guo
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jie Ning
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiai Li
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Zhigang Liu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China.,Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
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7
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Galeone A, Lebreton G, Coutance G, Demondion P, Schmidt M, Amour J, Varnous S, Leprince P. A single‐center long‐term experience with marginal donor utilization for heart transplantation. Clin Transplant 2020; 34:e14057. [DOI: 10.1111/ctr.14057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Antonella Galeone
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Guillaume Lebreton
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Guillaume Coutance
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Pierre Demondion
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Matthieu Schmidt
- Medical Intensive Care Unit Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Julien Amour
- Department of Anesthesiology Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Shaida Varnous
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
| | - Pascal Leprince
- Department of Thoracic and Cardiovascular Surgery Groupe Hospitalier Pitié‐Salpêtrière APHP Sorbonne Université Paris France
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8
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Guglin M, Zucker MJ, Borlaug BA, Breen E, Cleveland J, Johnson MR, Panjrath GS, Patel JK, Starling RC, Bozkurt B. Evaluation for Heart Transplantation and LVAD Implantation. J Am Coll Cardiol 2020; 75:1471-1487. [DOI: 10.1016/j.jacc.2020.01.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 12/11/2022]
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9
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Pal N, Gay SH, Boland CG, Lim AC. Heart Transplantation After Ventricular Assist Device Therapy: Benefits, Risks, and Outcomes. Semin Cardiothorac Vasc Anesth 2020; 24:9-23. [DOI: 10.1177/1089253219898985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Heart transplantation is an established treatment for end-stage heart failure. Due to the increase in demand and persistent scarcity of organ, mechanical circulatory devices have played a major role in therapy for advanced heart failure. Usage of left ventricular assist device (LVAD) has gone up from 6% in 2006 to 43% in 2013 as per the United Network of Organ Sharing database. Majority of patients presenting for a heart transplantation are often bridged with an assist device prior for management of heart failure while on wait-list. On one hand, it is well established that LVADs improve survival on wait-list; on the other hand, the effect of LVAD on morbidity and survival after a heart transplantation is still unclear. In this article, we review the available literature and attempt to infer the outcomes given the risks and benefits of heart transplantation with prior LVAD patients.
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Affiliation(s)
- Nirvik Pal
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Aaron C. Lim
- Virginia Commonwealth University, Richmond, VA, USA
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10
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Brown CR, Khurshan F, Chen Z, Groeneveld PW, McCarthy F, Acker M, Rame JE, Desai N. Optimal timing for heart transplantation in patients bridged with left ventricular assist devices: Is timing of the essence? J Thorac Cardiovasc Surg 2019; 157:2315-2324.e4. [DOI: 10.1016/j.jtcvs.2018.12.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 11/29/2018] [Accepted: 12/25/2018] [Indexed: 11/16/2022]
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11
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Theochari CA, Michalopoulos G, Oikonomou EK, Giannopoulos S, Doulamis IP, Villela MA, Kokkinidis DG. Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis. Ann Cardiothorac Surg 2018; 7:3-11. [PMID: 29492379 DOI: 10.21037/acs.2017.09.18] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The optimal treatment for advanced heart failure (HF) patients with regards to mortality remains unknown. Heart transplantation (HTx) and left ventricular assist devices (LVAD) used either as a bridge to transplant (BTT) or destination therapy (DT) have been compared in a number of studies, without definite conclusions with regards to mortality benefit. We sought to systematically review the pertinent literature and perform a meta-analysis of all the available studies presenting head-to-head comparisons between HTx and LVAD BTT or LVAD DT for late (>6 months) all-cause mortality. Methods We performed a systematic search of Medline and Cochrane Central databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a meta-analysis of late mortality comparing HTx vs. BTT LVAD and HTx vs. DT LVAD using a random effects model. Results Eight studies were included in our meta-analysis, reporting data on 7,957 patients in total. Although the available studies are of high quality [8 stars in Newcastle-Ottawa Scale (NOS) on average], there is paucity of mortality data. Specifically, seven studies compared HTx with BTT and five studies compared HTx with DT for 1-year mortality. Our pooled estimates showed that there was no difference in late mortality among these strategies. Conclusions Our meta-analysis highlights the small number and the heterogeneity of available studies referring to the optimal invasive management of advanced HF, and shows that there are no differences between HTx and LVAD for these patients with regards to late mortality.
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Affiliation(s)
- Christina A Theochari
- School of Medicine, University of Athens, Athens, Greece.,Division of Internal Medicine, Society of Junior Doctors, Marousi, Greece
| | - George Michalopoulos
- School of Medicine, University of Athens, Athens, Greece.,Division of Internal Medicine, Society of Junior Doctors, Marousi, Greece
| | | | | | - Ilias P Doulamis
- School of Medicine, University of Athens, Athens, Greece.,Division of Internal Medicine, Society of Junior Doctors, Marousi, Greece
| | - M Alvarez Villela
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Damianos G Kokkinidis
- Division of Internal Medicine, Society of Junior Doctors, Marousi, Greece.,Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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12
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Sabatino M, Vitale G, Manfredini V, Masetti M, Borgese L, Maria Raffa G, Loforte A, Martin Suarez S, Falletta C, Marinelli G, Clemenza F, Grigioni F, Potena L. Clinical relevance of the International Society for Heart and Lung Transplantation consensus classification of primary graft dysfunction after heart transplantation: Epidemiology, risk factors, and outcomes. J Heart Lung Transplant 2017; 36:1217-1225. [DOI: 10.1016/j.healun.2017.02.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 02/11/2017] [Accepted: 02/15/2017] [Indexed: 11/25/2022] Open
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13
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Heart Transplant Survival Based on Recipient and Donor Risk Scoring: A UNOS Database Analysis. ASAIO J 2017; 62:297-301. [PMID: 26771395 DOI: 10.1097/mat.0000000000000337] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Unlike the lung allocation score, currently, there is no quantitative scoring system available for patients on heart transplant waiting list. By using United Network for Organ Sharing (UNOS) data, we aim to generate a scoring system based on the recipient and donor risk factors to predict posttransplant survival. Available UNOS data were queried between 2005 and 2013 for heart transplant recipients aged ≥18 years to create separate cox-proportional hazard models for recipient and donor risk scoring. On the basis of risk scores, recipients were divided into five groups and donors into three groups. Kaplan-Meier curves were used for survival. Total 17,131 patients had heart transplant within specified time period. Major factors within high-risk groups were body mass index > 30 kg/m (46%), mean pulmonary artery pressure >30 mmHg (65%), creatinine > 1.5 mg% (63%), bilirubin > 1.5 mg% (54%), noncontinuous-flow left ventricular assist devices (45%) for recipients and gender mismatch (81%) and ischemia time >4 hours (88%) for donors. Survival in recipient groups 1, 2, 3, 4, and 5 at 5 years was 81, 80, 77, 74, and 62%, respectively, and in donor groups 1, 2, and 3 at 5 years was 79, 77, and 70%, respectively (p < 0.001). Combining donor and recipient groups based on scoring showed acceptable survival in low-risk recipients with high-risk donor (75% at 5 years). A higher recipient and donor risk score are associated with worse long-term survival. A low-risk recipient transplanted with high-risk donor has acceptable survival at 5 years, but high-risk recipient combined with a high-risk donor has marginal results. Using an objective scoring system could help get the best results when utilizing high-risk donors.
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14
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Left Ventricular Assist Devices: Challenges Toward Sustaining Long-Term Patient Care. Ann Biomed Eng 2017; 45:1836-1851. [DOI: 10.1007/s10439-017-1858-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/22/2017] [Indexed: 11/25/2022]
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15
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The Paradoxical Relationship Between Donor Distance and Survival After Heart Transplantation. Ann Thorac Surg 2017; 103:1384-1391. [DOI: 10.1016/j.athoracsur.2017.01.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/01/2016] [Accepted: 01/10/2017] [Indexed: 11/18/2022]
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16
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Zuk K, Gahl B, Susac M, Vierecke J, de By TM, Windecker S, Englberger L, Carrel T, Hetzer R, Gummert J, Mohacsi P. Mid-term mechanical circulatory support: comparison of single-centre data with the EUROMACS registry. Eur J Cardiothorac Surg 2016; 51:127-134. [DOI: 10.1093/ejcts/ezw256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/16/2016] [Accepted: 06/22/2016] [Indexed: 12/16/2022] Open
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Cheng A, Schumer EM, Trivedi JR, Van Berkel VH, Massey HT, Slaughter MS. Does Donor Cardiopulmonary Resuscitation Time Affect Heart Transplantation Outcomes and Survival? Ann Thorac Surg 2016; 102:751-758. [DOI: 10.1016/j.athoracsur.2016.02.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/04/2016] [Accepted: 02/09/2016] [Indexed: 11/28/2022]
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Ammirati E, Cipriani MG, Varrenti M, Colombo T, Garascia A, Cannata A, Pedrazzini G, Benazzi E, Milazzo F, Oliva F, Gagliardone MP, Russo CF, Frigerio M. A prospective comparison of mid-term outcomes in patients treated with heart transplantation with advanced age donors versus left ventricular assist device implantation. Interact Cardiovasc Thorac Surg 2016; 23:584-92. [DOI: 10.1093/icvts/ivw164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/26/2016] [Indexed: 11/13/2022] Open
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Spiliopoulos S, Koerfer R, Tenderich G. Early Outcomes With Marginal Donor Hearts Compared With Left Ventricular Assist Device Support in Patients With Advanced Heart Failure: Could the Cardiac Allocation Score Be the Solution to the Dilemma of Therapy Selection? Ann Thorac Surg 2016; 101:1630. [PMID: 27000597 DOI: 10.1016/j.athoracsur.2015.08.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 08/22/2015] [Accepted: 08/31/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Sotirios Spiliopoulos
- Department for the Surgical Therapy of End-Stage Heart Failure and Mechanical Circulatory Support, Heart and Vascular Center Duisburg, Fahrner St 133-135, 47169 Duisburg, Germany.
| | - Reiner Koerfer
- Department for the Surgical Therapy of End-Stage Heart Failure and Mechanical Circulatory Support, Heart and Vascular Center Duisburg, Fahrner St 133-135, 47169 Duisburg, Germany
| | - Gero Tenderich
- Department for the Surgical Therapy of End-Stage Heart Failure and Mechanical Circulatory Support, Heart and Vascular Center Duisburg, Fahrner St 133-135, 47169 Duisburg, Germany
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Schumer EM, Trivedi JR, Slaughter MS, Cheng A. Reply. Ann Thorac Surg 2016; 101:1630-1. [PMID: 27000598 DOI: 10.1016/j.athoracsur.2015.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 10/11/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Erin M Schumer
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Ste 1200, Louisville, KY 40202
| | - Jaimin R Trivedi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Ste 1200, Louisville, KY 40202
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Ste 1200, Louisville, KY 40202
| | - Allen Cheng
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Ste 1200, Louisville, KY 40202.
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Cheng A. Minimally invasive left ventricular assist device placement. J Vis Surg 2015; 1:25. [PMID: 29075614 DOI: 10.3978/j.issn.2221-2965.2015.12.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 11/23/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND The use of left ventricular assist device (LVAD) as bridge-to-transplant and destination therapy has increased significantly in the recent years along with the rapidly increasing heart failure patient population worldwide. It is crucial to be familiar with the standard surgical technique of LVAD implantation, but also to further advance the technique to optimize patient outcomes. Numerous studies have shown minimally invasive cardiac surgeries, including cardiac valves procedures can improve patient outcomes with decrease post-operative bleeding, reduced blood transfusion requirement, shorter hospital stay, faster recovery rate and lower hospital cost. With the advancement of mechanical circulatory support, the smaller and current generation of centrifugal continuous-flow LVADs has made minimally invasive LVAD implantation feasible. In this review, we described our surgical technique of minimally invasive LVAD placement. METHODS In addition to the standard pre-LVAD implantation evaluation, multiple studies, including chest radiography, chest computed tomography and echocardiography are further examined for patient selection and planning of the operation. Instead of a full standard sternotomy, a lateral mini-thoracotomy and hemi-sternotomy or second intercostal space anterior mini-thoracotomy are utilized. Special techniques are also applied to allow easy access for future re-entry, e.g., heart transplantation and to improve post-operative outcomes. Off-pump approach is our prefer approach for the minimally invasive procedure. RESULTS With minimally invasive approach, avoiding a full sternotomy, can reduce surgical trauma and post-operative bleeding, and can make subsequent LVAD explantation and heart transplantation less technically challenging and will allow patients to have a faster post-operative recovery rate. With the intact pericardium, the right ventricle can be protected from acute unrestricted dilation and further right heart failure after LVAD placement. The use of off-pump approach allows the avoidance of cardiopulmonary bypass and will decrease the incidence of post-operative vasoplegia and coagulopathy. CONCLUSIONS With the current generation of LVADs, minimally invasive surgical approach is very feasible and may improve patient outcomes. Further large prospective randomized studies will help to further demonstrate the potential advantages and disadvantage of minimally invasive LVAD placement. The upcoming generations of LVADs and minimally invasive instrumentations are currently being evaluate and will further advance the success of LVAD therapy.
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Affiliation(s)
- Allen Cheng
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, USA
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Schumer EM, Black MC, Monreal G, Slaughter MS. Left ventricular assist devices: current controversies and future directions. Eur Heart J 2015; 37:3434-3439. [PMID: 26543045 DOI: 10.1093/eurheartj/ehv590] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 08/04/2015] [Accepted: 10/12/2015] [Indexed: 11/12/2022] Open
Abstract
Advanced heart failure is a growing epidemic that leads to significant suffering and economic losses. The development of left ventricular assist devices (LVADs) has led to improved quality of life and long-term survival for patients diagnosed with this devastating condition. This review briefly summarizes the short history and clinical outcomes of LVADs and focuses on the current controversies and issues facing LVAD therapy. Finally, the future directions for the role of LVADs in the treatment of end-stage heart failure are discussed.
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Affiliation(s)
- Erin M Schumer
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202, USA
| | - Matthew C Black
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202, USA
| | - Gretel Monreal
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202, USA
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202, USA
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Schumer EM, Ising MS, Slaughter MS. The current state of left ventricular assist devices: challenges facing further development. Expert Rev Cardiovasc Ther 2015; 13:1185-93. [DOI: 10.1586/14779072.2015.1098534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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