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Ventricular Assist Devices and Increased Blood Product Utilization for Cardiac Transplantation
Author(s) -
Stone Matthew L.,
LaPar Damien J.,
Benrashid Ehsan,
Scalzo David C.,
Ailawadi Gorav,
Kron Irving L.,
Bergin James D.,
Blank Randal S.,
Kern John A.
Publication year - 2015
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.12474
Subject(s) - medicine , transplantation , blood product , ventricular assist device , incidence (geometry) , creatinine , heart transplantation , statistical significance , surgery , blood transfusion , cardiology , heart failure , physics , optics
A BSTRACT Background and Aim of Study The purpose of this study was to examine whether blood product utilization, one‐year cell‐mediated rejection rates, and mid‐term survival significantly differ for ventricular assist device (VAD patients compared to non‐VAD (NVAD) patients following cardiac transplantation. Methods From July 2004 to August 2011, 79 patients underwent cardiac transplantation at a single institution. Following exclusion of patients bridged to transplantation with VADs other than the HeartMate II® LVAD (n = 10), patients were stratified by VAD presence at transplantation: VAD patients (n = 35, age: 54.0 [48.0–59.0] years) vs. NVAD patients (n = 34, age: 52.5 [42.8–59.3] years). The primary outcomes of interest were blood product transfusion requirements, one‐year cell‐mediated rejection rates, and mid‐term survival post‐transplantation. Results Preoperative patient characteristics were similar for VAD and NVAD patients. NVAD patients presented with higher median preoperative creatinine levels compared to VAD patients (1.3 [1.1–1.6] vs. 1.1 [0.9–1.4], p = 0.004). VAD patients accrued higher intraoperative transfusion of all blood products (all p ≤ 0.001) compared to NVAD patients. The incidence of clinically significant cell‐mediated rejection within the first posttransplant year was higher in VAD compared to NVAD patients (66.7% vs. 33.3%, p = 0.02). During a median follow‐up period of 3.2 (2.0, 6.3) years, VAD patients demonstrated an increased postoperative mortality that did not reach statistical significance (20.0% vs. 8.8%, p = 0.20). Conclusions During the initial era as a bridge to transplantation, the HeartMate II® LVAD significantly increased blood product utilization and one‐year cell‐mediated rejection rates for cardiac transplantation. Further study is warranted to optimize anticoagulation strategies and to define causal relationships between these factors for the current era of cardiac transplantation. doi: 10.1111/jocs.12474 (J Card Surg 2015;30:194–200)