Cardiac transplant outcome of patients supported on left ventricular assist device vs intravenous inotropic therapy

Background: Although the left ventricular assist device (LVAD) has been inc reasingly used as a bridge to transplant, its effect on post-transplant out come is uncertain. We, therefore, designed this study using the Cardiac Tra nsplant Research Database to compare patients supported on an LVAD before t ransplant with those treated with intravenous inotropic medical therapy. Methods and Results: Of the 5,880 patients transplanted between 1990 and 19 97, a total of 502 received support from LVADs and 2,514 received intraveno us inotropic medical therapy at the time of transplant. Kaplan-Meier analys is showed no significant difference in post-transplant survival between the LVAD and medical-therapy groups (p = 0.09). Results of a multivariate Cox regression analysis were consistent with that of the Kaplan-Meier analysis and did not identify LVAD as a significant risk factor for mortality. The p ercentage of patients who received LVADs as a function of total transplants increased from 2% in 1990 to 16% in 1997. Furthermore, although the number of extracorporeal LVADs remained relatively constant, the number of intrac orporeal LVADs increased over time. Multivariate parametric analysis found that the risk factors for post-transplant death in the LVAD group were extr acorporeal LVAD use (p = 0.0004), elevated serum creatinine (p = 0.05), old er donor age (p = 0.03), increased donor ischemic time (p < 0.0001), and ea rlier year of transplant (p = 0.03). Conclusions: Given a limited donor supply, the intracorporeal LVAD helps th e sickest patients survive to transplant and provides post-transplant outco me similar to that of patients supported on inotropic medical therapy. Ther efore, patients supported on LVADs before transplant may receive the greate st marginal benefit when compared with other transplant candidates.