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DOI: 10.1055/s-0036-1571585
LVAD Bridging to Heart Transplantation Outcomes could be Significantly Improved with ex-vivo Normothermic Graft Preservation
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.