Thomas DiSalvo
Last active: 2/19/2015

Institutional volume of heart transplantation with left ventricular assist device explantation influences graft survival.

Haglund NA, Feurer ID, Ahmad RM, DiSalvo TG, Lenihan DJ, Keebler ME, Schlendorf KH, Stulak JM, Wigger MA, Maltais S
J Heart Lung Transplant. 2014 33 (9): 931-6

PMID: 24925183 · PMCID: PMC4130762 · DOI:10.1016/j.healun.2014.04.016

BACKGROUND - There are increasing numbers of patients undergoing orthotopic heart transplantation (OHT) with left ventricular assist device (LVAD) explantation (LVAD explant-OHT). We hypothesized that LVAD explant-OHT is a more challenging surgical procedure compared to OHT without LVAD explantation and that institutional LVAD explant-OHT procedural volume would be associated with post-transplant graft survival. We sought to assess the impact of institutional volume of LVAD explant-OHT on post-transplant graft survival.

METHODS - This is a retrospective analysis of the Scientific Registry of Transplant Recipients for adult OHTs with long-term LVAD explantation. LVAD explant-OHT volume was characterized on the basis of the center's year-specific total OHT volume (OHTvol) and year-specific LVAD explant-OHT volume quartile (LVADvolQ). The effect of LVADvolQ on graft survival (death or re-transplantation) was analyzed.

RESULTS - From 2004 to 2011, 2,681 patients underwent OHT with LVAD explantation (740 with HeartMate XVE, 1,877 with HeartMate II and 64 with HeartWare devices). LVAD explant-OHT at centers falling in the lowest LVADvolQ was associated with reduced post-transplant graft survival (p = 0.022). After adjusting for annualized OHTvol (HR = 0.998, 95% CI 0.993 to 1.003, p = 0.515 and pulsatile XVE (HR = 0.842, 95% CI 0.688 to 1.032, p = 0.098), multivariate analysis confirmed a significantly (approximately 37%) increased risk of post-transplant graft failure among explant-OHT procedures occurring at centers in the lowest volume quartile (HR = 1.371, 95% CI 1.030 to 1.825, p = 0.030).

CONCLUSION - Graft survival is decreased when performed at centers falling in the lowest quartile of LVAD explant-OHT for a given year. This volume-survival relationship should be considered in the context of limited donor organ availability and the rapidly growing number of LVAD centers.

Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

MeSH Terms (22)

Adolescent Adult Aged Device Removal Female Graft Rejection Graft Survival Heart-Assist Devices Heart Failure Heart Transplantation Hospitals, Low-Volume Humans Incidence Male Middle Aged Multivariate Analysis Registries Retrospective Studies Survival Rate Treatment Outcome Ventricular Dysfunction, Left Young Adult

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