TY - JOUR
T1 - Impact of bridge-to-bridge strategies from paracorporeal to implantable left ventricular assist devices on the pre-heart transplant outcome
T2 - A single-center analysis of 134 cases
AU - Nakajima Doi, Seiko
AU - Seguchi, Osamu
AU - Yamamoto, Masahiro
AU - Fujita, Tomoyuki
AU - Fukushima, Satsuki
AU - Mochizuki, Hiroki
AU - Iwasaki, Keiichiro
AU - Kimura, Yuki
AU - Toda, Koichi
AU - Kumai, Yuto
AU - Kuroda, Kensuke
AU - Watanabe, Takuya
AU - Yanase, Masanobu
AU - Kobayashi, Junjiro
AU - Kimura, Takeshi
AU - Fukushima, Norihide
N1 - Publisher Copyright:
© 2020
PY - 2021/4
Y1 - 2021/4
N2 - Background: In Japan, patients with heart failure who have a paracorporeal left ventricular assist device (pLVAD) and cannot be weaned from the VAD may undergo conversion to implantable continuous-flow LVAD (iLVAD) via a bridge-to-bridge (BTB) strategy for bridge-to-transplantation (BTT). This study aimed to evaluate the real-world clinical status of BTB strategies. Methods: Among 134 patients who underwent iLVAD implantation for BTT, 34 patients underwent conversion from pLVAD to iLVAD (BTB group) and 100 patients underwent iLVAD implantation primarily (primary iLVAD group). The clinical characteristics and outcomes were compared between the two groups. Results: No significant difference was found in the overall survival between the two groups (p = 0.26; log-rank test). However, the 1-year survival rate and the 1-year freedom from the composite events of death, stroke, systemic infection, and bleeding rate were lower in the BTB group than in the primary iLVAD group (survival rate, 88.2% vs. 99.0%, p = 0.0040; composite event-free survival rate, 26.1% vs. 49.8%, p = 0.030; log-rank test). Multivariate analysis indicated that the BTB strategy [hazard ratio (HR) 1.70, 95% confidence intervals (CI) 1.03–2.72; p=0.036] and serum total bilirubin levels at iLVAD implantation [HR 1.31, 95% CI 1.00–1.65; p=0.043] were independent predictors of 1-year composite events. Conclusions: The BTB strategy is useful in providing long-term survival in patients with acute critical diseases. However, the early mortality rate after conversion is higher in patients who underwent the BTB strategy.
AB - Background: In Japan, patients with heart failure who have a paracorporeal left ventricular assist device (pLVAD) and cannot be weaned from the VAD may undergo conversion to implantable continuous-flow LVAD (iLVAD) via a bridge-to-bridge (BTB) strategy for bridge-to-transplantation (BTT). This study aimed to evaluate the real-world clinical status of BTB strategies. Methods: Among 134 patients who underwent iLVAD implantation for BTT, 34 patients underwent conversion from pLVAD to iLVAD (BTB group) and 100 patients underwent iLVAD implantation primarily (primary iLVAD group). The clinical characteristics and outcomes were compared between the two groups. Results: No significant difference was found in the overall survival between the two groups (p = 0.26; log-rank test). However, the 1-year survival rate and the 1-year freedom from the composite events of death, stroke, systemic infection, and bleeding rate were lower in the BTB group than in the primary iLVAD group (survival rate, 88.2% vs. 99.0%, p = 0.0040; composite event-free survival rate, 26.1% vs. 49.8%, p = 0.030; log-rank test). Multivariate analysis indicated that the BTB strategy [hazard ratio (HR) 1.70, 95% confidence intervals (CI) 1.03–2.72; p=0.036] and serum total bilirubin levels at iLVAD implantation [HR 1.31, 95% CI 1.00–1.65; p=0.043] were independent predictors of 1-year composite events. Conclusions: The BTB strategy is useful in providing long-term survival in patients with acute critical diseases. However, the early mortality rate after conversion is higher in patients who underwent the BTB strategy.
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U2 - 10.1016/j.jjcc.2020.11.003
DO - 10.1016/j.jjcc.2020.11.003
M3 - Article
C2 - 33243529
AN - SCOPUS:85097111870
SN - 0914-5087
VL - 77
SP - 408
EP - 416
JO - Journal of cardiology
JF - Journal of cardiology
IS - 4
ER -