Predictors of survival in patients bridged to transplantation with the Thoratec VAD device: A single-center retrospective study on more than 100 patients

Background: Careful patient selection markedly influences the outcome of pa tients who undergo mechanical circulatory support. Therefore, we tried to e valuate predictors of survival after implantation of the Thoratec ventricul ar assist device (VAD). Methods: Between October 1992 and January 2000, 104 patients (86 men, 18 wo men, aged 11 to 69 years) received the Thoratec VAD as a bridge to transpla nt. A total of 51 patients required left ventricular support (LVAD), 50 pat ients required biventricular support (BVAD), and 3 patients required total artificial heart implantation. We performed univariate analysis of 25 param eters with regard to their effect on survival and then applied a multivaria te analysis to evaluate those factors that turned out to be marginally sign ificant. We performed all analysis for the total collective as well as for the LVAD and BVAD sub-group. Results: The BVAD patients tended to have worse outcomes than did LVAD pati ents. We found no significant predictors of survival in either sub-group. I n the total collective, however, we found the following pre-implant conditi ons were independent risk factors for survival after VAD implantation: pati ent age >60 years (odds ratio [OR] 3.87, confidence interval [CI] 1.39 to 1 0.76), pre-implant ventilation (OR, 6.76; CI 2.42 to 18.84), and increased pre-implant total bilirubin (OR, 1.42; CL, 1.19 to 1.69). Conclusions: Transplant candidates on inotropic support should be considere d for bridging to transplant as soon as bilirubin values start to increase or before respiratory function deteriorates and ventilation becomes necessa ry. In elderly patients, careful patient selection, particularly considerin g potential risk factors, might favorably affect their outcomes.