Outcome of patients on heart transplant list treated with a continuous-flow left ventricular assist device : Insights from the TRans-Atlantic registry on VAd and TrAnsplant (TRAViATA)
(2021) In International Journal of Cardiology 324.- Abstract
Background: Geographic variations in management and outcomes of individuals supported by continuous-flow left ventricular assist devices (CF-LVAD) between the United States (US) and Europe (EU) is largely unknown. Methods: We created a retrospective, multinational registry of 524 patients who received a CF-LVAD (either HVAD or Heartmate II) between January 2008 and April 2017. Follow up spanned from date of CF-LVAD implant to post-HTx period with a median follow up of 44.8 months. Results: The cohort included 299 (57.1%) EU and 225 (42.9%) US patients. Although the US cohort was significantly older with a higher prevalence of comorbidities, survival was similar between the cohorts (US 63.1%, EU 68.4% at 5 years, unadjusted log-rank test... (More)
Background: Geographic variations in management and outcomes of individuals supported by continuous-flow left ventricular assist devices (CF-LVAD) between the United States (US) and Europe (EU) is largely unknown. Methods: We created a retrospective, multinational registry of 524 patients who received a CF-LVAD (either HVAD or Heartmate II) between January 2008 and April 2017. Follow up spanned from date of CF-LVAD implant to post-HTx period with a median follow up of 44.8 months. Results: The cohort included 299 (57.1%) EU and 225 (42.9%) US patients. Although the US cohort was significantly older with a higher prevalence of comorbidities, survival was similar between the cohorts (US 63.1%, EU 68.4% at 5 years, unadjusted log-rank test p = 0.43).Multivariate analyses suggested that older age, higher body mass index, elevated creatinine, use of temporary mechanical circulatory support prior CF-LVAD, and implantation of HVAD were associated with increased mortality. Among CF-LVAD patients undergoing HTx, the median time on CF-LVAD support was shorter in the US, meanwhile US donors were younger. Finally, the pattern of adverse events (stroke, gastrointestinal bleedings, late right ventricular failure, and driveline infection) during support differed significantly between US and EU. Conclusions: Although waitlisted patients in the US on CF-LVAD have higher risk comorbid conditions, the overall outcome is similar in US and EU. Geographic variations with regards to donor characteristics, duration of CF-LVAD support prior to transplant, and adverse events on support can explain the disparity in the utilization of mechanical bridge to transplant strategy between US and EU.
(Less)
- author
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Bridge to transplantation, Continuous flow left ventricular assist device, Donor heart, Heart transplant list, Heart transplantation, Outcome
- in
- International Journal of Cardiology
- volume
- 324
- publisher
- Elsevier
- external identifiers
-
- scopus:85092441388
- pmid:32950592
- ISSN
- 0167-5273
- DOI
- 10.1016/j.ijcard.2020.09.026
- language
- English
- LU publication?
- yes
- id
- 6ea37c23-7a8f-4154-9bac-0323779d5b98
- date added to LUP
- 2021-01-08 13:30:53
- date last changed
- 2024-06-27 05:21:51
@article{6ea37c23-7a8f-4154-9bac-0323779d5b98,
abstract = {{<p>Background: Geographic variations in management and outcomes of individuals supported by continuous-flow left ventricular assist devices (CF-LVAD) between the United States (US) and Europe (EU) is largely unknown. Methods: We created a retrospective, multinational registry of 524 patients who received a CF-LVAD (either HVAD or Heartmate II) between January 2008 and April 2017. Follow up spanned from date of CF-LVAD implant to post-HTx period with a median follow up of 44.8 months. Results: The cohort included 299 (57.1%) EU and 225 (42.9%) US patients. Although the US cohort was significantly older with a higher prevalence of comorbidities, survival was similar between the cohorts (US 63.1%, EU 68.4% at 5 years, unadjusted log-rank test p = 0.43).Multivariate analyses suggested that older age, higher body mass index, elevated creatinine, use of temporary mechanical circulatory support prior CF-LVAD, and implantation of HVAD were associated with increased mortality. Among CF-LVAD patients undergoing HTx, the median time on CF-LVAD support was shorter in the US, meanwhile US donors were younger. Finally, the pattern of adverse events (stroke, gastrointestinal bleedings, late right ventricular failure, and driveline infection) during support differed significantly between US and EU. Conclusions: Although waitlisted patients in the US on CF-LVAD have higher risk comorbid conditions, the overall outcome is similar in US and EU. Geographic variations with regards to donor characteristics, duration of CF-LVAD support prior to transplant, and adverse events on support can explain the disparity in the utilization of mechanical bridge to transplant strategy between US and EU.</p>}},
author = {{Ammirati, Enrico and Brambatti, Michela and Braun, Oscar and Shah, Palak and Cipriani, Manlio and Bui, Quan M. and Veenis, Jesse and Lee, Euyhyun and Xu, Ronghui and Hong, Kimberly N. and Van de Heyning, Caroline M. and Perna, Enrico and Timmermans, Philippe and Cikes, Maja and Brugts, Jasper J. and Veronese, Giacomo and Minto, Jonathan and Smith, Saige and Gjesdal, Grunde and Gernhofer, Yan K. and Partida, Cynthia and Potena, Luciano and Masetti, Marco and Boschi, Silvia and Loforte, Antonio and Jakus, Nina and Milicic, Davor and Nilsson, Johan and De Bock, Dina and Sterken, Caroline and Van den Bossche, Klaartje and Rega, Filip and Tran, Hao and Singh, Ramesh and Montomoli, Jonathan and Mondino, Michele and Greenberg, Barry and Russo, Claudio F. and Pretorius, Victor and Liviu, Klein and Frigerio, Maria and Adler, Eric D.}},
issn = {{0167-5273}},
keywords = {{Bridge to transplantation; Continuous flow left ventricular assist device; Donor heart; Heart transplant list; Heart transplantation; Outcome}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{International Journal of Cardiology}},
title = {{Outcome of patients on heart transplant list treated with a continuous-flow left ventricular assist device : Insights from the TRans-Atlantic registry on VAd and TrAnsplant (TRAViATA)}},
url = {{http://dx.doi.org/10.1016/j.ijcard.2020.09.026}},
doi = {{10.1016/j.ijcard.2020.09.026}},
volume = {{324}},
year = {{2021}},
}