005 FIFTEEN YEAR EXPERIENCE OF BRIDGING TO HEART TRANSPLANTATION WITH VENTRICULAR ASSIST DEVICES

Abstract

Purpose: An increasing number of end-stage heart failure patients are being bridged to heart transplant (BTT) with ventricular assist devices (VAD). We reviewed a single-centre experience of BTT over a 15 year period with long term follow up. Methods and Materials: This is a retrospective study of 529 consecutive patients who underwent heart transplantation between April 1st, 1997 and July 31st, 2012. 466 were standard orthotopic heart transplants (OHT) without prior VAD support and 63 were BTT. The primary outcome was actuarial post-transplant survival. Other outcomes included blood lost within first 24 hours, return to theatre, intubation time, renal failure, gastro-intestinal complication, intensive care and total length of hospitalization. Results: The mean age of BTT patients was younger (OHT 49 yo, BTT 41 yo, p<0.01). There was a slightly lower 30-day survival in the BTT group (OHT 92%; BTT 85%) but there were no differences in 1-yr, 5-yr and q10-yr survival between groups (OHT 84%,75%,61%; BTT 82%, 74% ,58% ,log-ranktest p=0.47). The BTT group had a higher incidence of complications post-transplant: prolonged ventilation time (hours) (20(plus or minus)35 vs. 11 (plus or minus)54, p<0.01), pancreatitis (5% vs. 0.04%), blood loss in the first 24h (mls.) (840(plus or minus)2000 vs. 580(plus or minus)860, p<0.01) and ITU stay (days) (5(plus or minus) 10.8 vs. 3(plus or minus)6.6, p<0.01). There was no difference between groups regarding total hospital length of stay (22.6(plus or minus)20 vs. 22(plus or minus)17, p=0.76). (Graph presented) Conclusions: The use of ventricular assist devices as bridge to transplantation provides excellent posttransplant survival when compared to standard heart transplants. However, surgery for VAD explant and heart transplant can be demanding and is accompanied by higher perioperative morbidity without increasing length of stay.