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?

STS/EACTS Latin America Cardiovascular Surgery Conference 20174

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

STS/EACTS Latin America Cardiovascular Surgery Conference 20177

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

STS/EACTS Latin America Cardiovascular Surgery Conference 20179

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

STS/EACTS Latin America Cardiovascular Surgery Conference 201716

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