Temporal trends and outcomes of patients waiting on left ventricular assist devices and inotropes for heart transplantation
- 1 June 2020
- journal article
- research article
- Published by Wiley in Clinical Transplantation
- Vol. 34 (6), e13857
- https://doi.org/10.1111/ctr.13857
Abstract
We sought to evaluate the trends and outcomes of patients with left ventricular assist devices (LVADs) and inotropes at the time of listing for heart transplantation. Adults with an LVAD implanted and listed with 1A status were identified in the United Network for Organ Sharing (UNOS) registry between 2010 and 2017. Patients were grouped according to the presence or absence of inotropes at the time of listing and transplantation. A total of 2714 patients were included in the study including 664 patients on inotropes at the time of listing, 235 at the time of transplantation, and 118 on inotropes both at listing and at the time of transplantation. Patients on LVAD and inotropes at the time of listing were more frequently supported with a right ventricular assist device (RVAD) (P < .001), had higher risk of death in the waiting list (sub-hazard ratio [SHR] = 1.48, 95% CI 1.14-1.90,P = .002), and were less likely to be transplanted (SHR = 0.70, 95% CI 0.63-0.78,P < .001) compared with those not on inotropes, after adjusting for described confounders. Approximately 1 in 10 LVAD recipients listed as status 1A are on inotropic therapy at the time of heart transplantation. Patients on LVAD and inotropes have worse outcomes in terms of survival and lower rates of transplantation.This publication has 13 references indexed in Scilit:
- “Unintended” Consequences of Changes in Heart Transplant Allocation Policy: Impact on Practice PatternsASAIO Journal, 2020
- A Fully Magnetically Levitated Left Ventricular Assist Device — Final ReportThe New England Journal of Medicine, 2019
- Intrapericardial Left Ventricular Assist Device for Advanced Heart FailureThe New England Journal of Medicine, 2017
- The incidence, risk factors, and outcomes associated with late right-sided heart failure in patients supported with an axial-flow left ventricular assist deviceThe Journal of Heart and Lung Transplantation, 2017
- Ventricular Assist Devices or Inotropic Agents in Status 1A Patients? Survival Analysis of the United Network of Organ Sharing DatabaseThe Annals of Thoracic Surgery, 2014
- The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: Executive summaryThe Journal of Heart and Lung Transplantation, 2013
- Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: Incidence, risk factors, and effect on outcomesThe Journal of Thoracic and Cardiovascular Surgery, 2010
- Clinical management of continuous-flow left ventricular assist devices in advanced heart failureThe Journal of Heart and Lung Transplantation, 2010
- Risk Factors Predictive of Right Ventricular Failure After Left Ventricular Assist Device ImplantationThe American Journal of Cardiology, 2010
- The Right Ventricular Failure Risk Score: A Pre-Operative Tool for Assessing the Risk of Right Ventricular Failure in Left Ventricular Assist Device CandidatesJournal of the American College of Cardiology, 2008