Eastern Cardiothoracic Surgical Society

Requirement of Right Ventricular Assist Device Results in Worse Post-Transplant Survival
Sharven Taghavi1, Senthil Jayarajan1, Eugene Komaroff1, Abeel Mangi2, 1Temple University Hospital, Philadelphia, PA, 2Yale University School of Medicine, New Haven, CT


OBJECTIVE: The need for right ventricular assist device (RVAD) increases mortality in patients with left ventricular assist device (LVAD). However, how the requirement for RVAD affects outcomes after heart transplantation (OHT) has not been studied in a multi-institutional database.

METHODS: The United Network for Organ Sharing (UNOS) database was queried for all adult OHT from 2005-2012. Patients requiring RVAD in addition to LVAD as a bridge to transplantation were compared to all other patients receiving OHT. Cox proportional hazards analysis using covariates associated with mortality was used to examine survival.

RESULTS: There were 16,955 OHT during the study period. Of these, 476 (2.8%) required RVAD prior to transplantation. The RVAD group was older (44.8 vs. 47.0 years, p=0.001), more likely male (69.4 vs. 74.8%, p=0.01), and more likely to require mechanical ventilation prior to OHT (4.9 vs. 7.1%, p=0.03). Donors in the RVAD cohort were older (27.8 vs. 30.1 years, p<0.001), more likely male (69.4 vs. 74.8%, p=0.01) and had longer ischemic time (3.30 vs. 3.59 hours, p<0.001). Acute rejection episodes on index hospitalization was not different (15.6 vs. 17.1%, p=0.42). However, the RVAD group had increased length of stay (20.9 vs. 25.5 days, p<0.001). Median survival was lower in the RVAD cohort by Kaplan-Meier analysis (p=0.03). On multivariate analysis, requirement of RVAD was associated with mortality (HR: 1.22, 95%CI: 1.01-1.49, p=0.04). All other variables associated with mortality are shown (table).

CONCLUSIONS: The requirement of an RVAD prior to OHT is associated with worse post-operative outcomes and increased mortality.

Multiple Variable Model Showing Risk of Mortality

Hazards
Ratio
95%
Confidence
Interval

p-Value

Sex Mismatch 1.14 1.05-1.24

0.002

African American 1.40 1.28-1.54

<0.001

Ischemic Time (per hour) 1.13 1.09-1.16

<0.001

Recipient Creatinine (per mg/dL) 1.09 1.06-1.11

<0.001

Donor Age (per year) 1.01 1.01-1.02

<0.001

Plasma Reactive Antigen Panel >10% 1.12 1.00-1.25

0.047

Recipient Diabetes 1.11 1.01-1.21

0.03

Mechanical Ventilation as a Bridge to Transplantation 1.85 1.59-2.14

<0.001

Extracorporeal Membrane Oxygenation as a Bridge to Transplantation 2.51 2.03-3.11

<0.001