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Mid-term survival after continuous-flow left ventricular assist device versus heart transplantation

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Abstract

There is a paucity of data about mid-term outcome of patients with advanced heart failure (HF) treated with left ventricular assist device (LVAD) in Europe, where donor shortage and their aging limit the availability and the probability of success of heart transplantation (HTx). The aim of this study is to compare Italian single-centre mid-term outcome in prospective patients treated with LVAD vs. HTx. We evaluated 213 consecutive patients with advanced HF who underwent continuous-flow LVAD implant or HTx from 1/2006 to 2/2012, with complete follow-up at 1 year (3/2013). We compared outcome in patients who received a LVAD (n = 49) with those who underwent HTx (n = 164) and in matched groups of 39 LVAD and 39 HTx patients. Patients that were treated with LVAD had a worse risk profile in comparison with HTx patients. Kaplan–Meier survival curves estimated a one-year survival of 75.5 % in LVAD vs. 82.3 % in HTx patients, a difference that was non-statistically significant [hazard ratio (HR) 1.46; 95 % confidence interval (CI) 0.74–2.86; p = 0.27 for LVAD vs. HTx]. After group matching 1-year survival was similar between LVAD (76.9 %) and HTx (79.5 %; HR 1.15; 95 % CI 0.44–2.98; p = 0.78). Concordant data was observed at 2-year follow-up. Patients treated with LVAD as bridge-to-transplant indication (n = 22) showed a non significant better outcome compared with HTx with a 95.5 and 90.9 % survival, at 1- and 2-year follow-up, respectively. Despite worse preoperative conditions, survival is not significantly lower after LVAD than after HTx at 2-year follow-up. Given the scarce number of donors for HTx, LVAD therapy represents a valid option, potentially affecting the current allocation strategy of heart donors also in Europe.

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References

  1. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Kober L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Ronnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Bonet LA, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Flachskampf FA, Guida GF, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Orn S, Parissis JT, Ponikowski P (2012) Esc guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the european society of cardiology. Developed in collaboration with the heart failure association (hfa) of the esc. Eur Heart J 33:1787–1847

    Article  PubMed  Google Scholar 

  2. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW (2009) 2009 focused update incorporated into the acc/aha 2005 guidelines for the diagnosis and management of heart failure in adults: a report of the American college of cardiology foundation/american heart association task force on practice guidelines: developed in collaboration with the international society for heart and lung transplantation. Circulation 119:e391–e479

    Article  PubMed  Google Scholar 

  3. Bruschi G, Colombo T, Oliva F, Morici N, Botta L, Cannata A, Frigerio M, Martinelli L (2011) Orthotopic heart transplantation with donors greater than or equal to 60 years of age: a single-center experience. Eur J Cardiothorac Surg 40:e55–e61

    Article  PubMed  Google Scholar 

  4. Rogers JG, Aaronson KD, Boyle AJ, Russell SD, Milano CA, Pagani FD, Edwards BS, Park S, John R, Conte JV, Farrar DJ, Slaughter MS (2010) Continuous flow left ventricular assist device improves functional capacity and quality of life of advanced heart failure patients. J Am Coll Cardiol 55:1826–1834

    Article  PubMed  Google Scholar 

  5. Slaughter MS, Rogers JG, Milano CA, Russell SD, Conte JV, Feldman D, Sun B, Tatooles AJ, Delgado RM 3rd, Long JW, Wozniak TC, Ghumman W, Farrar DJ, Frazier OH (2009) Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med 361:2241–2251

    Article  CAS  PubMed  Google Scholar 

  6. Miller LW, Pagani FD, Russell SD, John R, Boyle AJ, Aaronson KD, Conte JV, Naka Y, Mancini D, Delgado RM, MacGillivray TE, Farrar DJ, Frazier OH (2007) Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med 357:885–896

    Article  CAS  PubMed  Google Scholar 

  7. Peura JL, Colvin-Adams M, Francis GS, Grady KL, Hoffman TM, Jessup M, John R, Kiernan MS, Mitchell JE, O’Connell JB, Pagani FD, Petty M, Ravichandran P, Rogers JG, Semigran MJ, Toole JM, On behalf of the American Heart Association Heart F, Transplantation Committee of the Council on Clinical Cardiology CoCCCP, Resuscitation CoCDitYC (2012) Recommendations for the use of mechanical circulatory support: device strategies and patient selection: a scientific statement from the american heart association. Circulation 126:2648–2667

  8. Kugler C, Malehsa D, Tegtbur U, Guetzlaff E, Meyer AL, Bara C, Haverich A, Strueber M (2011) Health-related quality of life and exercise tolerance in recipients of heart transplants and left ventricular assist devices: a prospective, comparative study. J Heart Lung Transplant 30:204–210

    Article  PubMed  Google Scholar 

  9. Park SJ, Milano CA, Tatooles AJ, Rogers JG, Adamson RM, Steidley DE, Ewald GA, Sundareswaran KS, Farrar DJ, Slaughter MS, HeartMate IICI (2012) Outcomes in advanced heart failure patients with left ventricular assist devices for destination therapy. Circ Heart Fail 5:241–248

    Article  PubMed  Google Scholar 

  10. Jorde UP, Kushwaha SS, Tatooles AJ, Naka Y, Bhat G, Long JW, Horstmanshof DA, Kormos RL, Teuteberg JJ, Slaughter MS, Birks EJ, Farrar DJ, Park SJ, HeartMate IICI (2014) Results of the destination therapy post-food and drug administration approval study with a continuous flow left ventricular assist device: a prospective study using the intermacs registry (interagency registry for mechanically assisted circulatory support). J Am Coll Cardiol 63:1751–1757

    Article  PubMed  Google Scholar 

  11. Aaronson KD, Slaughter MS, Miller LW, McGee EC, Cotts WG, Acker MA, Jessup ML, Gregoric ID, Loyalka P, Frazier OH, Jeevanandam V, Anderson AS, Kormos RL, Teuteberg JJ, Levy WC, Naftel DC, Bittman RM, Pagani FD, Hathaway DR, Boyce SW (2012) HeartWare ventricular assist device bridge to transplant ATI. Use of an intrapericardial, continuous-flow, centrifugal pump in patients awaiting heart transplantation. Circulation 125:3191–3200

    Article  PubMed  Google Scholar 

  12. Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Miller MA, Timothy Baldwin J, Young JB (2014) Sixth intermacs annual report: a 10,000-patient database. J Heart Lung Transplant 33:555–564

    Article  PubMed  Google Scholar 

  13. Starling RC, Naka Y, Boyle AJ, Gonzalez-Stawinski G, John R, Jorde U, Russell SD, Conte JV, Aaronson KD, McGee EC Jr, Cotts WG, DeNofrio D, Pham DT, Farrar DJ, Pagani FD (2011) Results of the post-u.S. Food and drug administration-approval study with a continuous flow left ventricular assist device as a bridge to heart transplantation: a prospective study using the intermacs (interagency registry for mechanically assisted circulatory support). J Am Coll Cardiol 57:1890–1898

    Article  PubMed  Google Scholar 

  14. Dandel M, Weng Y, Siniawski H, Stepanenko A, Krabatsch T, Potapov E, Lehmkuhl HB, Knosalla C, Hetzer R (2011) Heart failure reversal by ventricular unloading in patients with chronic cardiomyopathy: criteria for weaning from ventricular assist devices. Eur Heart J 32:1148–1160

    Article  PubMed  PubMed Central  Google Scholar 

  15. Drews T, Dandel M, Krabatsch T, Potapov E, Stepanenko A, Hennig E, Lehmkuhl HB, Pasic M, Weng Y, Hetzer R (2011) Long-term mechanical circulatory support in 198 patients: largest single-center experience worldwide. ASAIO J 57:9–16

    Article  PubMed  Google Scholar 

  16. Williams ML, Trivedi JR, McCants KC, Prabhu SD, Birks EJ, Oliver L, Slaughter MS (2011) Heart transplant vs left ventricular assist device in heart transplant-eligible patients. Ann Thorac Surg 91:1330–1333 (discussion 1333–1334)

    Article  PubMed  Google Scholar 

  17. Daneshmand MA, Rajagopal K, Lima B, Khorram N, Blue LJ, Lodge AJ, Hernandez AF, Rogers JG, Milano CA (2010) Left ventricular assist device destination therapy versus extended criteria cardiac transplant. Ann Thorac Surg 89:1205–1209 (discussion 1210)

    Article  PubMed  Google Scholar 

  18. Frigerio M, Gronda EG, Mangiavacchi M, Andreuzzi B, Colombo T, De Vita C, Oliva F, Quaini E, Pellegrini A (1997) Restrictive criteria for heart transplantation candidacy maximize survival of patients with advanced heart failure. J Heart Lung Transplant 16:160–168

    CAS  PubMed  Google Scholar 

  19. Colombo T, Vitali E, Lanfranconi M, Russo C, Bruschi G, Marchetti C, Colucci V, Frigerio M, Oliva F, Grassi M, Gronda E, Merli M, Pellegrini A (1998) Heart transplantation 1985-1998: 13-years experience at angelo de gasperis cardio-thoracic department-milan. Clin Transpl:315–325

  20. Mehra MR, Kobashigawa J, Starling R, Russell S, Uber PA, Parameshwar J, Mohacsi P, Augustine S, Aaronson K, Barr M (2006) Listing criteria for heart transplantation: international society for heart and lung transplantation guidelines for the care of cardiac transplant candidates–2006. J Heart Lung Transplant 25:1024–1042

    Article  PubMed  Google Scholar 

  21. Ammirati E, Oliva F, Colombo T, Botta L, Cipriani M, Cannata A, Verde A, Turazza FM, Russo CF, Paino R, Martinelli L, Frigerio M (2013) proposal for updated listing criteria for heart transplantation and indications to implant of left ventricular assist devices. G Ital Cardiol (Rome). 14:110–119

    Google Scholar 

  22. Ammirati E, Oliva F, Cannata A, Contri R, Colombo T, Martinelli L, Frigerio M (2014) Current indications for heart transplantation and left ventricular assist device: a practical point of view. Eur J Intern Med 25:422–429

    Article  PubMed  Google Scholar 

  23. Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S, Fedson S, Fisher P, Gonzales-Stawinski G, Martinelli L, McGiffin D, Smith J, Taylor D, Meiser B, Webber S, Baran D, Carboni M, Dengler T, Feldman D, Frigerio M, Kfoury A, Kim D, Kobashigawa J, Shullo M, Stehlik J, Teuteberg J, Uber P, Zuckermann A, Hunt S, Burch M, Bhat G, Canter C, Chinnock R, Crespo-Leiro M, Delgado R, Dobbels F, Grady K, Kao W, Lamour J, Parry G, Patel J, Pini D, Towbin J, Wolfel G, Delgado D, Eisen H, Goldberg L, Hosenpud J, Johnson M, Keogh A, Lewis C, O’Connell J, Rogers J, Ross H, Russell S, Vanhaecke J (2010) The international society of heart and lung transplantation guidelines for the care of heart transplant recipients. J Heart Lung Transplant 29:914–956

    Article  PubMed  Google Scholar 

  24. Stehlik J, Edwards LB, Kucheryavaya AY, Aurora P, Christie JD, Kirk R, Dobbels F, Rahmel AO, Hertz MI (2010) The registry of the international society for heart and lung transplantation: twenty-seventh official adult heart transplant report–2010. J Heart Lung Transpl 29:1089–1103

    Article  Google Scholar 

  25. Dellgren G, Geiran O, Lemstrom K, Gustafsson F, Eiskjaer H, Koul B, Hagerman I, Selimovic N (2013) Nordic Thoracic Transplant Study G. Three decades of heart transplantation in scandinavia: long-term follow-up. Eur J Heart Fail 15:308–315

    Article  PubMed  Google Scholar 

  26. Matthews JC, Pagani FD, Haft JW, Koelling TM, Naftel DC, Aaronson KD (2010) Model for end-stage liver disease score predicts left ventricular assist device operative transfusion requirements, morbidity, and mortality. Circulation 121:214–220

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kormos RL, Teuteberg JJ, Pagani FD, Russell SD, John R, Miller LW, Massey T, Milano CA, Moazami N, Sundareswaran KS, Farrar DJ (2010) Right ventricular failure in patients with the heartmate ii continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg 139:1316–1324

    Article  PubMed  Google Scholar 

  28. Ammirati E, Cipriani M, De Chiara B, D’Angelo L, Belli O, Moreo A, Oliva F, Martinelli L, Frigerio M (2014) Left ventricular or bi-ventricular assist device? How dobutamine stress echocardiography can untie the dilemma of right ventricular dysfunction. Int J Cardiol 177:e6–e8

    Article  PubMed  Google Scholar 

  29. Cipriani M, De Chiara B, Ammirati E, Roghi A, D’Angelo L, Oliva F, Moreo A, Bonacina E, Martinelli L (2014) right ventricular dysfunction in advanced heart failure. G Ital Cardiol (Rome) 15:430–440

    Google Scholar 

  30. Grant AD, Smedira NG, Starling RC, Marwick TH (2012) Independent and incremental role of quantitative right ventricular evaluation for the prediction of right ventricular failure after left ventricular assist device implantation. J Am Coll Cardiol 60:521–528

    Article  PubMed  Google Scholar 

  31. Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA, Morgan JA, Arabia F, Bauman ME, Buchholz HW, Deng M, Dickstein ML, El-Banayosy A, Elliot T, Goldstein DJ, Grady KL, Jones K, Hryniewicz K, John R, Kaan A, Kusne S, Loebe M, Massicotte MP, Moazami N, Mohacsi P, Mooney M, Nelson T, Pagani F, Perry W, Potapov EV, Eduardo Rame J, Russell SD, Sorensen EN, Sun B, Strueber M, Mangi AA, Petty MG, Rogers J (2013) The 2013 international society for heart and lung transplantation guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant 32:157–187

    Article  PubMed  Google Scholar 

  32. Miller LW, Guglin M (2013) Patient selection for ventricular assist devices: a moving target. J Am Coll Cardiol 61:1209–1221

    Article  PubMed  Google Scholar 

  33. Forest SJ, Bello R, Friedmann P, Casazza D, Nucci C, Shin JJ, D’Alessandro D, Stevens G, Goldstein DJ (2013) Readmissions after ventricular assist device: etiologies, patterns, and days out of hospital. Ann Thorac Surg 95:1276–1281

    Article  PubMed  Google Scholar 

  34. Hasin T, Marmor Y, Kremers W, Topilsky Y, Severson CJ, Schirger JA, Boilson BA, Clavell AL, Rodeheffer RJ, Frantz RP, Edwards BS, Pereira NL, Stulak JM, Joyce L, Daly R, Park SJ, Kushwaha SS (2013) Readmissions after implantation of axial flow left ventricular assist device. J Am Coll Cardiol 61:153–163

    Article  PubMed  Google Scholar 

  35. Stevenson LW, Miller LW, Desvigne-Nickens P, Ascheim DD, Parides MK, Renlund DG, Oren RM, Krueger SK, Costanzo MR, Wann LS, Levitan RG, Mancini D (2004) Left ventricular assist device as destination for patients undergoing intravenous inotropic therapy: a subset analysis from rematch (randomized evaluation of mechanical assistance in treatment of chronic heart failure). Circulation 110:975–981

    Article  PubMed  Google Scholar 

  36. Scrutinio D, Ammirati E, Guida P, Passantino A, Raimondo R, Guida V, Sarzi Braga S, Canova P, Mastropasqua F, Frigerio M, Lagioia R, Oliva F (2014) The adhf/nt-probnp risk score to predict 1-year mortality in hospitalized patients with advanced decompensated heart failure. J Heart Lung Transplant 33:404–411

    Article  PubMed  Google Scholar 

  37. Scrutinio D, Ammirati E, Guida P, Passantino A, Raimondo R, Guida V, Sarzi Braga S, Pedretti RF, Lagioia R, Frigerio M, Catanzaro R, Oliva F (2013) Clinical utility of n-terminal pro-b-type natriuretic peptide for risk stratification of patients with acute decompensated heart failure. Derivation and validation of the adhf/nt-probnp risk score. Int J Cardiol 168:2120–2126

    Article  PubMed  Google Scholar 

  38. Sato T, Yamauchi H, Suzuki S, Yoshihisa A, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh SI, Takeishi Y (2014) Serum cholinesterase is an important prognostic factor in chronic heart failure. Heart Vessels. doi:10.1007/s00380-014-0469-8

    Google Scholar 

  39. Antonini L, Mollica C, Auriti A, Pristipino C, Pasceri V, Leone F, Greco S (2014) A prognostic index for risk stratification for acute heart failure and death in subjects with ischemic cardiomyopathy and cardiac defibrillator. Heart Vessels. doi:10.1007/s00380-014-0494-7

    Google Scholar 

  40. Brouwers C, Denollet J, de Jonge N, Caliskan K, Kealy J, Pedersen SS (2011) Patient-reported outcomes in left ventricular assist device therapy: a systematic review and recommendations for clinical research and practice. Circ Heart Fail 4:714–723

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Dr. Carlo V. Cannistraci, Dr. Ewa Aurelia Miendlarzewska and Dr. Rachele Contri for proofreading the article. We thank Dr. Giliola Calori, San Raffaele Scientific Institute, Milan, Italy, for statistical support in matching procedure. Supported in part by Fondazione Angelo De Gasperis. Enrico Ammirati received financial support from the “Giovane Ricercatore 2009 Grant” from Italian Health Ministry (project code GR-2009-1608780).

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    Authors and Affiliations

    1. Cardiothoracic and Vascular Department, Azienda Ospedaliera Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy

      Enrico Ammirati, Fabrizio G. Oliva, Tiziano Colombo, Claudio F. Russo, Manlio G. Cipriani, Andrea Garascia, Valentina Guida, Giulia Colombo, Alessandro Verde, Enrico Perna, Aldo Cannata, Roberto Paino, Luigi Martinelli & Maria Frigerio

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    1. Enrico Ammirati
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    2. Fabrizio G. Oliva
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    Correspondence to Enrico Ammirati or Maria Frigerio.

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    E. Ammirati and F. G. Oliva authors contributed equally.

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    Ammirati, E., Oliva, F.G., Colombo, T. et al. Mid-term survival after continuous-flow left ventricular assist device versus heart transplantation. Heart Vessels 31, 722–733 (2016). https://doi.org/10.1007/s00380-015-0654-4

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