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Lawrence R. McBride
Keith S. Naunheim
Andrew C. Fiore
Robert G. Johnson
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Ann Thorac Surg 2001;71:1839-1844
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Risk analysis in patients bridged to transplantation

Lawrence R. McBride, MDa, Keith S. Naunheim, MDa, Andrew C. Fiore, MDa, Robert G. Johnson, MDa, Debbie A. Moroney, RNa, Jenny A. Brannan, RN, MSNa, Marc T. Swartza

a Department of Surgery, Cardiothoracic Division, Saint Louis University School of Medicine, St. Louis, Missouri, USA

Address reprint requests to Mr Swartz, Department of Surgery, Division of Cardiothoracic Surgery, 3635 Vista Ave at Grand Blvd, St. Louis, MO 63110
e-mail: swartzmt{at}slu.edu

Presented at the Forty-seventh Annual Meeting of the Southern Thoracic Surgical Association, Marco Island, FL, Nov 9–11, 2000.

Background. Efforts to predict mortality in bridge to cardiac transplant patients have concentrated on pre-ventricular assist device (VAD) status. To more 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 post-VAD), including hemodynamics, 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 analysis 23 of 64 factors were significant. These 23 factors were entered into a stepwise logistic regression analysis to identify predictors of survival to transplant. Four factors, including pre-VAD intubation (p < 0.005), cardiopulmonary bypass (CPB) time during VAD insertion (p < 0.0001), mean pulmonary artery pressure (first postoperative day after VAD) (p < 0.0002), and highest post-VAD creatinine (p < 0.01) were independent predictors of transplantation.

Conclusions. Other than the need for intubation, pre-VAD variables were of little value in predicting survival to transplant. Problems during VAD insertion (long CPB time) and post-VAD renal insufficiency were independent predictors. Severe complications that developed during the interval of VAD support, including cerebrovascular accident, bleeding and infection, were surprisingly not predictors for transplantation.




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[Abstract] [Full Text] [PDF]


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