Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Feb 26, 2017; 9(2): 154-161
Published online Feb 26, 2017. doi: 10.4330/wjc.v9.i2.154
Optimal timing of same-admission orthotopic heart transplantation after left ventricular assist device implantation
Gunsagar Gulati, David Ouyang, Richard Ha, Dipanjan Banerjee
Gunsagar Gulati, David Ouyang, Dipanjan Banerjee, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
Richard Ha, Department of Cardiothoracic Surgery, Division of Adult Cardiac Surgery, Stanford University, Stanford, CA 94305, United States
Author contributions: All authors contributed substantially to the study; Gulati G, Ouyang D and Banerjee D designed the research; Gulati G and Ouyang D contributed equally to this work, performed the analysis, interpreted the results, and drafted the manuscript; Ha R and Banerjee D provided clinical advice and supervised the report.
Institutional review board statement: The study used de-identified, publicly available data, which does not require evaluation by the Institutional Review Board (IRB).
Informed consent statement: Patients were not required to give informed consent because the study used de-identified, publicly available data.
Conflict-of-interest statement: Dr. Dipanjan Banerjee reports research support from HeartWare/Medtronic and Thoratec/St. Jude. None of the other listed authors have any disclosures or potential conflicts of interest.
Data sharing statement: The statistical methods and original anonymous dataset are available on request from the corresponding author at dipanjan@stanford.edu.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dipanjan Banerjee, MD, MS, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Dr MC 5319, Rm A260, Stanford, CA 94305, United States. dipanjan@stanford.edu
Telephone: +1-650-7236459 Fax: +1-650-7238392
Received: October 14, 2016
Peer-review started: October 17, 2016
First decision: November 14, 2016
Revised: November 25, 2016
Accepted: December 13, 2016
Article in press: December 15, 2016
Published online: February 26, 2017
Processing time: 132 Days and 9.6 Hours
Abstract
AIM

To investigate the impact of timing of same-admission orthotopic heart transplant (OHT) after left ventricular assist device (LVAD) implantation on in-hospital mortality and post-transplant length of stay.

METHODS

Using data from the Nationwide Inpatient Sample from 1998 to 2011, we identified patients 18 years of age or older who underwent implantation of a LVAD and for whom the procedure date was available. We calculated in-hospital mortality for those patients who underwent OHT during the same admission as a function of time from LVAD to OHT, adjusting for age, sex, race, household income, and number of comorbid diagnoses. Finally, we analyzed the effect of time to OHT after LVAD implantation on the length of hospital stay post-transplant.

RESULTS

Two thousand and two hundred patients underwent implantation of a LVAD in this cohort. One hundred and sixty-four (7.5%) patients also underwent OHT during the same admission, which occurred on average 32 d (IQR 7.75-66 d) after LVAD implantation. Of patients who underwent OHT, patients who underwent transplantation within 7 d of LVAD implantation (“early”) experienced increased in-hospital mortality (26.8% vs 12.2%, P = 0.0483) compared to patients who underwent transplant after 8 d (“late”). There was no statistically significant difference in age, sex, race, household income, or number of comorbid diagnoses between the early and late groups. Post-transplant length of stay after LVAD implantation was also not significantly different between patients who underwent early vs late OHT.

CONCLUSION

In this cohort of patients who received LVADs, the rate of in-hospital mortality after OHT was lower for patients who underwent late OHT (at least 8 d after LVAD implantation) compared to patients who underwent early OHT. Delayed timing of OHT after LVAD implantation did not correlate with longer hospital stays post-transplant.

Keywords: Mechanical circulatory support; Orthotopic heart transplant; Bridge to transplant; Left ventricular assist device outcomes

Core tip: The optimal timing of same-admission orthotopic heart transplantation (OHT) after the implantation of a left ventricular assist device (LVAD) is unknown. The need for clinical stability and time to recover from surgery is counterbalanced by the risk of LVAD complications and formation of adhesions and scarring, particularly when OHT is considered early after LVAD implantation. We reviewed adult patients in the Nationwide Inpatient Sample who underwent same-admission OHT after LVAD between 1998 and 2011. Compared to early transplantation after LVAD, OHT after 8 d of LVAD implantation was associated with decreased mortality risk without increased post-transplant length of stay.