Thorac Cardiovasc Surg 2016; 64 - OP140
DOI: 10.1055/s-0036-1571585

LVAD Bridging to Heart Transplantation Outcomes could be Significantly Improved with ex-vivo Normothermic Graft Preservation

D. Garcia Saez 1, B. Zych 1, P. Mohite 1, A. Sabashnikov 1, M. Zeriouh 1, A. F. Popov 1, A. Koch 1, C. T. Bowles 1, R. Hards 1, G. Edwards 1, M. Hedger 1, F. De Robertis 1, N. R. Banner 1, A. R. Simon 1
  • 1Harefield Hospital, Transplant, London, United Kingdom

Purpose: Continuous-flow left ventricular assist devices (cf-LVAD) are the standard of care for patients with advanced heart failure as a bridge to heart transplantation (HTx). However transplanting these patients is challenging and the international registries identify it as a risk factor for increased mortality. Ex vivo normothermic preservation minimizes the cold ischemic time and optimizes logistics and meticulous recipients preparation. We analyze the influence of ex-vivo graft perfusion on the outcome in LVAD patients bridged to HTx.

Methods: Retrospective study of all cf- LVAD patients bridged to HTx at a single center from July 2007 to March 2015 was performed. Outcomes in the patients transplanted until January 2013 with the grafts preserved with cold storage (CS) (n = 15) were compared with ex vivo normothermic preservation group (n = 24)

Results: During this period 236 patients were implanted with LVAD and 39 (16.5%) were bridged to HTx with n = 25; 60% of the patients on the current heart transplant waiting list on LVAD support.

15 patients were bridged to transplant with cold storage during the first 6 years vs 24 patients during the past 2 years using ex vivo preservation.

There was a trend toward increased donor age in the OCS group (40 ± 10 Vs 34 ± 11 yo; p = 0.08). There was also a trend toward prolonged transport time for OCS group > 150 minute (41.7% vs 13.3% CS) p = 0.083. Incidence of primary graft dysfunction requiring mechanical circulatory support was higher for the CS group (66.7% vs 25% OCS p = 0.01. Duration of inotropic support and mechanical ventilation, blood loss in 24h and blood product units transfused was significantly higher in the cold storage group. There was a trend toward increased Overall Cumulative Survival at year in the OCS 74.8% versus 53.3% CS.

Conclusions: The use of the Organ Care System in LVAD patients bridged to transplant optimizes the logistics and improves the short-term outcomes. We have increased the number of patients transplanted on long term LVAD support and it has become the standard of care in our clinical practice.