Abstract
The use of continuous flow (CF) left ventricular assist devices (LVAD) as a bridge to orthotopic heart transplantation (OHT) has increased. This study examined survival outcomes after CF-LVAD explantation and OHT using marginal donors. Adults undergoing OHT with or without LVAD explant using marginal donors between 2007 and 2014 were identified in the Scientific Registry for Transplant Recipients database. A previously validated donor risk score was used to define marginal donors. Patients were stratified into four groups based on utilization of a marginal donor with or without LVAD explantation at OHT. Graft survival was analyzed at 1 and 5 years. Overall, 7,798 patients with OHT were analyzed. Whereas 1,862 patients (24%) underwent direct OHT utilizing marginal donors, only 626 patients (30% [group A]) underwent OHT with LVAD explant (HeartMate II [Thoratec, Pleasanton, CA], n =581, 93%; HVAD [HeartWare, Framingham, MA], n = 45, 7%) and 1,236 (70%) underwent direct OHT (group B). Standard donors were utilized for 2,334 patients with CF-LVAD explant (group C), and 3,602 patients underwent direct OHT (group D). Utilization of marginal donors in patients undergoing LVAD explantation was associated with decreased posttransplant g...Continue Reading
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