Abstract 17320: Does the Duration of Continuous Flow Left Ventricular Assist Device Support Influence Survival Following Heart Transplantation?

Introduction: Bridge to transplant strategy with continuous-flow left ventricular assist devices (CF-LVADs) has become standard care for advanced heart failure patients. However, the impact of prolonged CF-LVAD support on transplant outcomes is unknown. This study aimed to assess the outcomes after cardiac transplantation in patients receiving long-term CF-LVAD support. Methods: United Network of Organ Sharing provided de-identified patient level data. Between January 2011 and December 2013, 7231 heart transplant recipients were identified. Of these, 2260 (31.3%) were bridged with CF-LVAD. The proportion of CF-LVAD bridged patients increased every year (27.8% in 2011, 29.9% in 2012, 35.7% in 2013, p<0.001). Recipients were stratified by the CF-LVAD duration at the time of transplantation: Group 1 (less than 1 year, n=1471, 65.1%), Group 2 (1 - 2 years, n=548, 24.2%), and Group 3 (more than 2 years, n=241, 10.7%). Results: The mean follow-up period and duration of CF-LVAD support of the entire cohort was 363 ± 270 and 349 ± 294 days, respectively. Recipients in Group 2 and 3 spent more time in status 1A (67.2, 105.1 versus 37.0 days, p< 0.001), had a greater body mass index (29.7, 30.3 versus 27.5, p<0.001) and serum creatinine (1.30, 1.39 versus 1.25, p=0.031), and more often received antibiotics prior to transplant than did patients in Group 1 (16.1, 22.4 versus 13.5%, p=0.001). The unadjusted 30-day survival was significantly worse for Group 3 patients (96.3, 95.8 versus 92.5%, p = 0.029). On the multivariate logistic regression analysis, the duration of CF-LVAD support more than 2 years was a significant risk factor for 30-day mortality (odds ratio, 2.16; 95% confidence interval (CI), 1.11-4.23; p = 0.024). The unadjusted 1-year survival rate demonstrated a trend towards worse survival in Group 3 (91.8, 92.2 versus 87.6%, p = 0.069), whereas no such trend was observed on multivariate Cox proportional hazards regression analysis. Conclusions: The duration of device support more than 2 years was an independent predictor of 30-day mortality. The observed difference may be explained by less favorable baseline characteristics of patients with prolonged device support. Early transplantation within 2-year LVAD support might be warranted.