Durable left ventricular assist device support as a bridge to heart transplant candidacy†.

Shaw, Steven M, Venkateswaran, Rajamiyer, Hogg, Rachel, Rushton, Sally, Al-Attar, Nawwar, Schueler, Stephan, Lim, Sern, Parameshwar, Jayan and Banner, Nicholas R (2019) Durable left ventricular assist device support as a bridge to heart transplant candidacy†. Interactive cardiovascular and thoracic surgery, 28 (4). pp. 594-601. ISSN 1569-9285.

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Official URL: https://academic.oup.com/icvts/article/28/4/594/51...

Abstract

OBJECTIVES

Left ventricular assist devices are funded in the UK exclusively as a bridge to transplant (BTT). However, patients who potentially could receive a transplant may develop reversible contraindications to transplant. Bridge to candidacy (BTC) has sometimes been controversial, given the uncertain clinical efficacy of BTC and the risk that reimbursement could be denied. We analysed the UK ventricular assist device database to understand how common BTC was and to assess patient survival rates and incidences of transplants.

METHODS

We identified BTC implants in patients with pulmonary hypertension, chronic kidney disease and obesity using the UK guidelines for heart transplants.

RESULTS

A total of 306 of 540 patients had complete data and 157 were identified as BTC (51%). Overall, there was no difference in survival rates between patients designated as BTC and those designated at BTT (71.9 vs 72.9% at 1 year, respectively; P = 0.82). However, the survival rate was lower at all time points in those with an estimated glomerular filtration rate (eGFR) <40 and in patients with a body mass index (BMI) >32 up to 1-year postimplant. There were no significant differences in the incidence of transplant between patients who were BTC and BTT or for any subgroup up to 5 years. However, we noted a diverging trend towards a lower cumulative incidence of transplant for patients with a BMI >32.

CONCLUSIONS

BTC is common in the UK and appears clinically effective, given that the survival rates and the incidence of transplants were comparable with those for BTT. Patients with a high BMI have a worse survival rate through to 1 year and a trend for a lower incidence of a transplant. Patients with a low eGFR also have a worse survival rate, but a similar proportion received transplants.

Item Type: Article
Subjects: WG Cardiovascular system. Cardiology
WO Surgery
Divisions: Emergency Services > Cardiology
Related URLs:
Depositing User: Beth Connors
Date Deposited: 26 Nov 2019 09:51
Last Modified: 26 Nov 2019 09:51
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2615

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