Ventricular assist devices and increased blood product utilization for cardiac transplantation

Matthew L. Stone; Damien J. Lapar; Ehsan Benrashid; David C. Scalzo; Gorav Ailawadi; Irving L. Kron; James D. Bergin; Randal S. Blank; John A. Kern

doi:10.1111/jocs.12474

Ventricular assist devices and increased blood product utilization for cardiac transplantation

Matthew L. Stone, Damien J. Lapar, Ehsan Benrashid, David C. Scalzo, Gorav Ailawadi, Irving L. Kron, James D. Bergin, Randal S. Blank, John A. Kern

Medicine Administration

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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

Original language	English (US)
Pages (from-to)	194-200
Number of pages	7
Journal	Journal of Cardiac Surgery
Volume	30
Issue number	2
DOIs	https://doi.org/10.1111/jocs.12474
State	Published - Feb 1 2015

ASJC Scopus subject areas

Surgery
Pulmonary and Respiratory Medicine
Cardiology and Cardiovascular Medicine

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@article{48ea79cfaf404cedab026b1ee250e6dd,

title = "Ventricular assist devices and increased blood product utilization for cardiac transplantation",

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{\textregistered} 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{\textregistered} 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",

author = "Stone, {Matthew L.} and Lapar, {Damien J.} and Ehsan Benrashid and Scalzo, {David C.} and Gorav Ailawadi and Kron, {Irving L.} and Bergin, {James D.} and Blank, {Randal S.} and Kern, {John A.}",

note = "Publisher Copyright: {\textcopyright} 2014 Wiley Periodicals, Inc.",

year = "2015",

month = feb,

day = "1",

doi = "10.1111/jocs.12474",

language = "English (US)",

volume = "30",

pages = "194--200",

journal = "Journal of Cardiac Surgery",

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T1 - Ventricular assist devices and increased blood product utilization for cardiac transplantation

AU - Stone, Matthew L.

AU - Lapar, Damien J.

AU - Benrashid, Ehsan

AU - Scalzo, David C.

AU - Ailawadi, Gorav

AU - Kron, Irving L.

AU - Bergin, James D.

AU - Blank, Randal S.

AU - Kern, John A.

PY - 2015/2/1

Y1 - 2015/2/1

N2 - 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

AB - 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

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Ventricular assist devices and increased blood product utilization for cardiac transplantation

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