Transplantation Direct (Jul 2017)

Reversibility of Frailty After Bridge-to-Transplant Ventricular Assist Device Implantation or Heart Transplantation

  • Sunita R. Jha, BMed Sci (Hons),
  • Malin K. Hannu, BMed Sci (Physio) M Occ Ther,
  • Phillip J. Newton, RN, PhD,
  • Kay Wilhelm, MBBS, MD, FRANZCP,
  • Christopher S. Hayward, MBBS, MD,
  • Andrew Jabbour, MBBS, PhD,
  • Eugene Kotlyar, MD,
  • Anne Keogh, MD,
  • Kumud Dhital, FRACS, PhD,
  • Emily Granger, FRACS,
  • Mark Connellan, MBBCh, FCCardio, MMed, FRACS,
  • Paul Jansz, FRACS, PhD,
  • Phillip M. Spratt, MBBS, FRCS, FRACS,
  • Elyn Montgomery, RN,
  • Angela Smith, RN,
  • Michelle Harkess, MCN,
  • Peta Tunicliff, RN,
  • Patricia M. Davidson, RN, PhD,
  • Peter S. Macdonald, MD, PhD

DOI
https://doi.org/10.1097/TXD.0000000000000690
Journal volume & issue
Vol. 3, no. 7
p. e167

Abstract

Read online

Background. We recently reported that frailty is independently predictive of increased mortality in patients with advanced heart failure referred for heart transplantation (HTx). The aim of this study was to assess the impact of frailty on short-term outcomes after bridge-to-transplant ventricular assist device (BTT-VAD) implantation and/or HTx and to determine if frailty is reversible after these procedures. Methods. Between August 2013 and August 2016, 100 of 126 consecutive patients underwent frailty assessment using Fried’s Frailty Phenotype before surgical intervention: 40 (21 nonfrail, 19 frail) BTT-VAD and 77 (60 nonfrail, 17 frail) HTx—including 17 of the 40 BTT-VAD supported patients. Postprocedural survival, intubation time, intensive care unit, and hospital length of stay were compared between frail and nonfrail groups. Twenty-six frail patients were reassessed at 2 months or longer postintervention. Results. Frail patients had lower survival (63 ± 10% vs 94 ± 3% at 1 year, P = 0.012) and experienced significantly longer intensive care unit (11 vs 5 days, P = 0.002) and hospital (49 vs 25 days, P = 0.003) length of stay after surgical intervention compared with nonfrail patients. Twelve of 13 frail patients improved their frailty score after VAD (4.0 ± 0.8 to 1.4 ± 1.1, P < 0.001) and 12 of 13 frail patients improved their frailty score after HTx (3.2 ± 0.4 to 0.9 ± 0.9, P < 0.001). Handgrip strength and depression improved postintervention. Only a slight improvement in cognitive function was seen postintervention. Conclusions. Frail patients with advanced heart failure experience increased mortality and morbidity after surgical intervention with BTT-VAD or HTx. Among those who survive frailty is partly or completely reversible underscoring the importance of considering this factor as a dynamic not fixed entity.