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Duration of LVAD Support Does Not Impact Post-Cardiac Transplant Survival in the Continuous-Flow Pump Era
Ranjit John1, Francis D. Pagani2, Yoshifumi Naka3, John V. Conte4, Charles T. Klodell5, Carmelo A. Milano6, David Farrar7, O howard Frazier8; 1Surgery, University of Minnesota, Minneapolis, MN; 2University of Michigan, Ann Arbor, MI; 3Columbia University, New York, NY; 4John Hopkins, Baltimore, MD; 5University of Florida, Gainsville, FL; 6Duke University, Durham, NC; 7Thoratec Corporation, Pleasanton, CA; 8Texas Heart Institute, Houston, TX
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Objective: Previous evaluations of pulsatile left ventricular assist devices (LVADs) have shown that transplantation either early after LVAD implantation (< 6 weeks) or late (>6 months) adversely affected post-cardiac transplant survival. We sought to determine if the post-transplant survival of patients supported with newer continuous flow LVADs was related to the duration of LVAD support.
Methods: The HeartMate II LVAD was implanted in 459 patients as a bridge-to-transplant at 33 centers in a multicenter trial. Patients were divided into 5 groups based on duration of LVAD support as shown in the Table. The median age was 55 (range 15 - 77), 45% had ischemic etiology, and 23% were females. Survival was determined at 30 days and 1 year post post-transplantation.
Results: Of 459 patients, 236 underwent cardiac transplant after a median duration of LVAD support of 143 days (longest: 3.2 yr), 87 died (19%), 12 (2.6%) recovered ventricular function and the device was removed, and 121 (26%) are still on LVAD support. There were no significant differences in baseline demographics among the 5 groups. The overall 30 day and 1-year post-TX survival was 97% and 90%. As shown in the Table, there were no significant differences in survival based on the duration of LVAD support.
Conclusion: Post-cardiac transplant survival is not influenced by the duration of LVAD support with continuous-flow devices. Their improved durability and reduced short and long-term morbidity has reduced the need for urgent cardiac transplantation which may have adversely influenced survival in the pulsatile LVAD era. This data may allow for better donor selection for patients on continuous-flow devices independent of LVAD duration, thereby favoring improved post-transplant outcomes.

Transplanted patients who have reached 30 days or 1 year since transplantation
LVAD Duration (Days) LVAD pts at start of interval Pts transplanted in interval Post-transplant survival
30 Days 1-year
0-30 459 19 100% 93%
30-89 408 60 100% 91%
90-179 311 63 95% 88%
180-365 24969 93% 93%
>365 109 24 100% 86%
Overall 97% 90%

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