Does A Pre-Left Ventricular Assist Device Screening Score Predict Long-Term Transplantation Success? A 2-Center Analysis
Background. A risk factor summation score was previously validated to successfully predict survival after insertion of a left ventricular assist device (LVAD). We investigated whether this scoring system also predicts clinical outcomes after eventual heart transplantation in LVAD recipients.
Methods. A retrospective review was performed on 153 consecutive patients who received an LVAD as a bridge to transplantation at 2 large-volume centers from 1996 to 2003. The scoring system was used to designate low- and high-scoring groups.
Results. Thirty-day mortality and 5-year survival after transplantation were equivalent between groups (4.46% versus 7.32% and 76% versus 70%, respectively). No difference was seen in length of posttransplantation ventilator dependence (2.83 ± 0.49 versus 3.3 ± 0.72 days) or intensive care unit monitoring (6.38 ± 0.77 versus 6.97 ± 1.1 days). However, low-scoring patients had a significantly decreased duration of inotrope support (5.57 ± 0.45 versus 7.74 ± 1.0 days, P = .035).
Conclusion. A risk factor summation score may predict which LVAD patients will require prolonged inotropic support following heart transplantation. However, survival in high-risk (elevated score) LVAD patients following heart transplantation is comparable to low-risk groups, favoring the continued practice of LVAD implantation as a bridge to transplantation even in high-risk patients.
Aaronson KD, Eppinger MJ, Dyke DB, et al. 2002. Left ventricular assist device therapy improves utilization of donor hearts. J Am Coll Cardiol 39:1247-54.nBank AJ, Mir SH, Nguyen DQ, et al. 2000. Effects of left ventricular assist devices on outcomes in patients undergoing heart transplantation. Ann Thorac Surg 69:1369-74.nGammie JS, Edwards LB, Griffith BP, et al. 2004. Optimal timing of cardiac transplantation after ventricular assist device implantation. J Thorac Cardiovasc Surg 127:1789-99.nKherani AR, Maybaum S, Oz MC. 2004. Ventricular assist devices as a bridge to transplant or recovery. Cardiology 101:93-103.nOz MC, Goldstein DJ, Pepino P, et al. 1995. Screening scale predicts patients successfully receiving long-term implantable left ventricular assist devices. Circulation 92(9 suppl):II169-73.nPeterze B, Lonn U, Jansson K, et al. 2002. Long-term follow-up of patients treated with an implantable left ventricular assist device as an extended bridge to heart transplantation. J Heart Lung Transplant 21:604-7.nRao V, Oz MC, Flannery MA, et al. 2003. Revised screening scale to predict survival following left ventricular assist device insertion. J Thorac Cardiovasc Surg 125:855-62.nRose EA, Gelijns AC, Moskowitz AJ, et al. 2001. Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) Study Group. NEJM 345:1435-43.n
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