Ventricular Assist Devices and Increased Blood Product Utilization for Cardiac Transplantation

• Published in: Journal of cardiac surgery Vol. 30; no. 2; pp. 194 - 200
• Main Authors: Stone, Matthew L., LaPar, Damien J., Benrashid, Ehsan, Scalzo, David C., Ailawadi, Gorav, Kron, Irving L., Bergin, James D., Blank, Randal S., Kern, John A.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-02-2015
• Subjects: Adult; Biological Products - therapeutic use; Blood Substitutes - therapeutic use; Drug Utilization - statistics & numerical data; Female; Follow-Up Studies; Graft Rejection - epidemiology; Heart Transplantation - methods; Heart Transplantation - mortality; Heart Transplantation - utilization; Heart-Assist Devices - statistics & numerical data; Humans; Male; Middle Aged; Survival Rate; Time Factors; Treatment Outcome
• ISSN: 0886-0440; 1540-8191
• DOI: 10.1111/jocs.12474

ABSTRACT
Background and Aim of Study
The purpose of this study was to examine whether blood product utilization, one‐year cell‐mediated rejection rates, and mid‐term survival significantly differ for ventricular assist device (VAD patients compared to non‐VAD (NVAD) patients following cardiac transplantation.
Methods
From July 2004 to August 2011, 79 patients underwent cardiac transplantation at a single institution. Following exclusion of patients bridged to transplantation with VADs other than the HeartMate II® LVAD (n = 10), patients were stratified by VAD presence at transplantation: VAD patients (n = 35, age: 54.0 [48.0–59.0] years) vs. NVAD patients (n = 34, age: 52.5 [42.8–59.3] years). The primary outcomes of interest were blood product transfusion requirements, one‐year cell‐mediated rejection rates, and mid‐term survival post‐transplantation.
Results
Preoperative patient characteristics were similar for VAD and NVAD patients. NVAD patients presented with higher median preoperative creatinine levels compared to VAD patients (1.3 [1.1–1.6] vs. 1.1 [0.9–1.4], p = 0.004). VAD patients accrued higher intraoperative transfusion of all blood products (all p ≤ 0.001) compared to NVAD patients. The incidence of clinically significant cell‐mediated rejection within the first posttransplant year was higher in VAD compared to NVAD patients (66.7% vs. 33.3%, p = 0.02). During a median follow‐up period of 3.2 (2.0, 6.3) years, VAD patients demonstrated an increased postoperative mortality that did not reach statistical significance (20.0% vs. 8.8%, p = 0.20).
Conclusions
During the initial era as a bridge to transplantation, the HeartMate II® LVAD significantly increased blood product utilization and one‐year cell‐mediated rejection rates for cardiac transplantation. Further study is warranted to optimize anticoagulation strategies and to define causal relationships between these factors for the current era of cardiac transplantation. doi: 10.1111/jocs.12474 (J Card Surg 2015;30:194–200)