Risk analysis in patients bridged to transplantation

Background. Efforts to predict mortality in bridge to cardiac transplant pa tients have concentrated on preventricular assist device (VAD) status. To m ore fully identify factors influencing survival to transplant, we reviewed the preoperative and postoperative VAD courses of 105 bridge to transplant patients, Methods. Sixty-four parameters (34 pre-VAD, 30 postVAD), including hemodyna mics, complications, and evaluations of major organ function were examined and analyzed. Results. Thirty-three patients (31%) died on VADs and 72 were transplanted. There were two posttransplant operative deaths (3%). By univariate analysi s 23 of 64 factors were significant. These 23 factors were entered into a s tepwise logistic regression analysis to identify predictors of survival to transplant. Four factors, including pre-VAD intubation (p < 0.005), cardiop ulmonary bypass (CPB) time during VAD insertion (p < 0.0001), mean pulmonar y artery pressure (first postoperative day after VAD) (p < 0.0002), and hig hest post-VAD creatinine (p < 0.01) were independent predictors of transpla ntation. Conclusions. Other than the need for intubation, pre-VAD variables were of little value in predicting survival to transplant. Problems during VAD inse rtion (long CPB time) and post-VAD renal insufficiency were independent pre dictors. Severe complications that developed during the interval of VAD sup port, including cerebrovascular accident, bleeding and infection, were surp risingly not predictors for transplantation.