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Outcomes of MCS as a Bridge to Heart Transplantation: Are We Compromising Short-and Long-term Outcomes?
US Heart Transplant: United Network Organ Sharing (UNOS) Report
STS/EACTS Latin America Cardiovascular Surgery Conference 20172Colvin et al. OPTN/SRTR 2015 Annual Data
Report: Heart. Am J Transplant. 2017
US Heart Transplant: United Network Organ Sharing (UNOS) Report
STS/EACTS Latin America Cardiovascular Surgery Conference 20173Colvin et al. OPTN/SRTR 2015 Annual Data
Report: Heart. Am J Transplant. 2017
Bridging to Heart Transplantation
• Increased competition for hearts has increased the use of durable LVADs as a bridge to heart transplant
• Has the use of durable LVAD adversely affected transplant outcomes?
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STS/EACTS Latin America Cardiovascular Surgery Conference 20175Trivedi et al. Ann Thorac Surg 2014;98:830–4
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ORIGINAL RESEARCH ARTICLEMorbidity and Mortality in Heart Transplant Candidates Supported with Mechanical Circulatory Support. Is Reappraisal of the Current UNOS Thoracic Organ Allocation Policy Justified?Omar Wever-Pinzon, Stavros G. Drakos, Abdallah G. Kfoury, Jose N. Nativi, Edward M. Gilbert, Melanie Everitt, Rami Alharethi, Kim Brunisholz, FerasM. Bader, Dean Y. Li, Craig H. Selzman, Josef Stehlik CF-LVAD
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ORIGINAL RESEARCH ARTICLEMorbidity and Mortality in Heart Transplant Candidates Supported with Mechanical Circulatory Support. Is Reappraisal of the Current UNOS Thoracic Organ Allocation Policy Justified?Omar Wever-Pinzon, Stavros G. Drakos, Abdallah G. Kfoury, Jose N. Nativi, Edward M. Gilbert, Melanie Everitt, Rami Alharethi, Kim Brunisholz, FerasM. Bader, Dean Y. Li, Craig H. Selzman, Josef Stehlik
LVAD without Complication
LVAD Complication
STS/EACTS Latin America Cardiovascular Surgery Conference 20178Cleveland et al. J Thorac Cardiovasc Surg 2008;136:774-7
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STS/EACTS Latin America Cardiovascular Surgery Conference 201710
Unadjusted Survival
*
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LVAD Bridge to Transplantation
• Survival to transplant improved compared to UNOS Status 1A bridged with inotropes or IABP
• LVAD complications adversely affect waitlist survival• Durable LVADs have superior outcomes compared to temporary
LVADs• The duration of bridging does not affect post-transplant survival
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Survival by Indication
STS/EACTS Latin America Cardiovascular Surgery Conference 2017Kirklin et al. Eighth Annual Intermacs Report: Special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017;xx:xx-xx. http://dx.doi.org/10.1016/j.healun.2017.07.005 13
Competing Outcomes for BTT Indication
STS/EACTS Latin America Cardiovascular Surgery Conference 2017Kirklin et al. Seventh Annual Intermacs Report: 15,000 patients and counting. J Heart Lung Transplant. 2017;34(12):1495-1504. 14
Survival by Intermacs Patient Profile
STS/EACTS Latin America Cardiovascular Surgery Conference 2017Kirklin et al. Eighth Annual Intermacs Report: Special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017;xx:xx-xx. http://dx.doi.org/10.1016/j.healun.2017.07.005 15
Survival by Degree of Renal Dysfunction
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STS/EACTS Latin America Cardiovascular Surgery Conference 201717Kirklin et al. J Heart Lung Transplant. 2015;34:1495-1504.
HeartMate 3 HeartMate II HVAD
Device Landscape 2017
This article was published on November 16,2016, at NEJM.org.DOI: 10.1056/NEJMoa1610426
HeartMate 3: US MOMENTUM TRIALShort Term Cohort: 6 Months
Conclusions• Durable LVADs improve survival to transplant over other bridging
strategies• Transplant outcomes are not affected unless bridging with LVAD
complication• Patient selection key to optimal outcomes• New devices offer reduced risk of device thrombosis
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Thank You