Impact of Continuous Flow Left Ventricular Assist Device on Heart Transplant Candidates: A Multi-State Survival Analysis

Massimiliano Carrozzini; Tomaso Bottio; Raphael Caraffa; Jonida Bejko; Olimpia Bifulco; Alvise Guariento; Carlo Mario Lombardi; Marco Metra; Danila Azzolina; Dario Gregori; Marny Fedrigo; Chiara Castellani; Vincenzo Tarzia; Giuseppe Toscano; Antonio Gambino; Vjola Jorgji; Enrico Ferrari; Annalisa Angelini; Gino Gerosa

doi:10.3390/jcm11123425

Journal of Clinical Medicine (Jun 2022)

Impact of Continuous Flow Left Ventricular Assist Device on Heart Transplant Candidates: A Multi-State Survival Analysis

Massimiliano Carrozzini,
Tomaso Bottio,
Raphael Caraffa,
Jonida Bejko,
Olimpia Bifulco,
Alvise Guariento,
Carlo Mario Lombardi,
Marco Metra,
Danila Azzolina,
Dario Gregori,
Marny Fedrigo,
Chiara Castellani,
Vincenzo Tarzia,
Giuseppe Toscano,
Antonio Gambino,
Vjola Jorgji,
Enrico Ferrari,
Annalisa Angelini,
Gino Gerosa

Affiliations

Massimiliano Carrozzini: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
Tomaso Bottio: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
Raphael Caraffa: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
Jonida Bejko: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
Olimpia Bifulco: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
Alvise Guariento: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
Carlo Mario Lombardi: Cardiothoracic Unit, Spedali Civili of Brescia, Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, 25121 Brescia, Italy
Marco Metra: Cardiothoracic Unit, Spedali Civili of Brescia, Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, 25121 Brescia, Italy
Danila Azzolina: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
Dario Gregori: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
Marny Fedrigo: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
Chiara Castellani: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
Vincenzo Tarzia: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
Giuseppe Toscano: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
Antonio Gambino: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
Vjola Jorgji: Hacohen Lab, Massachusetts General Hospital, Boston, MA 02114, USA
Enrico Ferrari: Cardiac Surgery Unit, Cardiocentro Ticino Institute, 6900 Lugano, Switzerland
Annalisa Angelini: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
Gino Gerosa: Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy

DOI: https://doi.org/10.3390/jcm11123425
Journal volume & issue: Vol. 11, no. 12
p. 3425

Abstract

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(1) Objectives: The aim of this study was to investigate the impact of the prolonged use of continuous-flow left ventricular assist devices (LVADs) on heart transplant (HTx) candidates. (2) Methods: Between January 2012 and December 2019, we included all consecutive patients diagnosed with end-stage heart failure considered for HTx at our institution, who were also eligible for LVAD therapy as a bridge to transplant (BTT). Patients were divided into two groups: those who received an LVAD as BTT (LVAD group) and those who were listed without durable support (No-LVAD group). (3) Results: A total of 250 patients were analyzed. Of these, 70 patients (28%) were directly implanted with an LVAD as BTT, 11 (4.4%) received delayed LVAD implantation, and 169 (67%) were never assisted with an implantable device. The mean follow-up time was 36 ± 29 months. In the multivariate analysis of survival before HTx, LVAD implantation showed a protective effect: LVAD vs. No-LVAD HR 0.01 (p p = 0.02). Mortality and adverse events after HTx were similar between LVAD and No-LVAD (p = 0.65 and p = 0.39, respectively). The multi-state survival analysis showed a significantly higher probability of death for No-LVAD vs. LVAD patients with (p = 0.03) or without (p = 0.04) HTx. (4) Conclusions: The use of LVAD as a bridge to transplant was associated with an overall survival benefit, compared to patients listed without LVAD support.

Published in Journal of Clinical Medicine

ISSN: 2077-0383 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine
Website: http://www.mdpi.com/journal/jcm

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