Long-term survival in patients with post-LVAD right ventricular failure: multi-state modelling with competing outcomes of heart transplant

Rohan Shad, Robyn Fong, Nicolas Quach, Cayley Bowles, Patpilai Kasinpila, Michelle Li, Kate Callon, Miguel Castro, Ashrith Guha, Erik E. Suarez, Sangjin Lee, Stefan Jovinge, Theodore Boeve, Yasuhiro Shudo, Curtis P. Langlotz, Jeffrey Teuteberg, William Hiesinger

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Multicenter data on long term survival following LVAD implantation that make use of contemporary definitions of RV failure are limited. Furthermore, traditional survival analyses censor patients who receive a bridge to heart transplant. Here we compare the outcomes of LVAD patients who develop post-operative RV failure accounting for the transitional probability of receiving an interim heart transplantation. Methods: We use a retrospective cohort of LVAD patients sourced from multiple high-volume centers based in the United States. Five- and ten-year survival accounting for transition probabilities of receiving a heart transplant were calculated using a multi-state Aalen Johansen survival model. Results: Of the 897 patients included in the study, 238 (26.5%) developed post-operative RV failure at index hospitalization. At 10 years the probability of death with post-op RV failure was 79.28% vs 61.70% in patients without (HR 2.10; 95% CI 1.72 – 2.57; p = < .001). Though not significant, patients with RV failure were less likely to be bridged to a heart transplant (HR 0.87, p = .4). Once transplanted the risk of death between both patient groups remained equivalent; the probability of death after a heart transplant was 3.97% in those with post-operative RV failure shortly after index LVAD implant, as compared to 14.71% in those without. Conclusions and relevance: Long-term durable mechanical circulatory support is associated with significantly higher mortality in patients who develop post-operative RV failure. Improving outcomes may necessitate expeditious bridge to heart transplant wherever appropriate, along with critical reassessment of organ allocation policies.

Original languageEnglish (US)
Pages (from-to)778-785
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume40
Issue number8
DOIs
StatePublished - Aug 2021

Keywords

  • heart failure
  • heart transplantation
  • left ventricular assist device
  • multi-state survival
  • right ventricular failure

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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