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)

Research output: Contribution to journalArticle

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 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.

Details

Authors
  • Enrico Ammirati
  • Michela Brambatti
  • Palak Shah
  • Manlio Cipriani
  • Quan M. Bui
  • Jesse Veenis
  • Euyhyun Lee
  • Ronghui Xu
  • Kimberly N. Hong
  • Caroline M. Van de Heyning
  • Enrico Perna
  • Philippe Timmermans
  • Maja Cikes
  • Jasper J. Brugts
  • Giacomo Veronese
  • Jonathan Minto
  • Saige Smith
  • Yan K. Gernhofer
  • Cynthia Partida
  • Luciano Potena
  • Marco Masetti
  • Silvia Boschi
  • Antonio Loforte
  • Nina Jakus
  • Davor Milicic
  • Johan Nilsson
  • Dina De Bock
  • Caroline Sterken
  • Klaartje Van den Bossche
  • Filip Rega
  • Hao Tran
  • Ramesh Singh
  • Jonathan Montomoli
  • Michele Mondino
  • Barry Greenberg
  • Claudio F. Russo
  • Victor Pretorius
  • Klein Liviu
  • Maria Frigerio
  • Eric D. Adler
Organisations
External organisations
  • Niguarda Hospital
  • Jonsson Comprehensive Cancer Center
  • Skåne University Hospital
  • Inova Heart and Vascular Institute
  • Erasmus University Medical Center
  • Altman Clinical and Translational Research Institute
  • University of California, San Diego
  • Antwerp University Hospital
  • University Hospitals Leuven
  • University Hospital of Infectious Diseases
  • University of Milano-Bicocca
  • University of California, San Francisco
  • St. Orsola-Malpighi University Hospital
  • Marche Polytechnic University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems

Keywords

  • Bridge to transplantation, Continuous flow left ventricular assist device, Donor heart, Heart transplant list, Heart transplantation, Outcome
Original languageEnglish
JournalInternational Journal of Cardiology
Publication statusE-pub ahead of print - 2020
Publication categoryResearch
Peer-reviewedYes