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Heart and Vessels
Published in: Heart and Vessels 5/2016

01-05-2016 | Original Article

Mid-term survival after continuous-flow left ventricular assist device versus heart transplantation

Authors: Enrico Ammirati, Fabrizio G. Oliva, Tiziano Colombo, Claudio F. Russo, Manlio G. Cipriani, Andrea Garascia, Valentina Guida, Giulia Colombo, Alessandro Verde, Enrico Perna, Aldo Cannata, Roberto Paino, Luigi Martinelli, Maria Frigerio

Published in: Heart and Vessels | Issue 5/2016

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Abstract

There is a paucity of data about mid-term outcome of patients with advanced heart failure (HF) treated with left ventricular assist device (LVAD) in Europe, where donor shortage and their aging limit the availability and the probability of success of heart transplantation (HTx). The aim of this study is to compare Italian single-centre mid-term outcome in prospective patients treated with LVAD vs. HTx. We evaluated 213 consecutive patients with advanced HF who underwent continuous-flow LVAD implant or HTx from 1/2006 to 2/2012, with complete follow-up at 1 year (3/2013). We compared outcome in patients who received a LVAD (n = 49) with those who underwent HTx (n = 164) and in matched groups of 39 LVAD and 39 HTx patients. Patients that were treated with LVAD had a worse risk profile in comparison with HTx patients. Kaplan–Meier survival curves estimated a one-year survival of 75.5 % in LVAD vs. 82.3 % in HTx patients, a difference that was non-statistically significant [hazard ratio (HR) 1.46; 95 % confidence interval (CI) 0.74–2.86; p = 0.27 for LVAD vs. HTx]. After group matching 1-year survival was similar between LVAD (76.9 %) and HTx (79.5 %; HR 1.15; 95 % CI 0.44–2.98; p = 0.78). Concordant data was observed at 2-year follow-up. Patients treated with LVAD as bridge-to-transplant indication (n = 22) showed a non significant better outcome compared with HTx with a 95.5 and 90.9 % survival, at 1- and 2-year follow-up, respectively. Despite worse preoperative conditions, survival is not significantly lower after LVAD than after HTx at 2-year follow-up. Given the scarce number of donors for HTx, LVAD therapy represents a valid option, potentially affecting the current allocation strategy of heart donors also in Europe.
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Metadata
Title
Mid-term survival after continuous-flow left ventricular assist device versus heart transplantation
Authors
Enrico Ammirati
Fabrizio G. Oliva
Tiziano Colombo
Claudio F. Russo
Manlio G. Cipriani
Andrea Garascia
Valentina Guida
Giulia Colombo
Alessandro Verde
Enrico Perna
Aldo Cannata
Roberto Paino
Luigi Martinelli
Maria Frigerio
Publication date
01-05-2016
Publisher
Springer Japan
Published in
Heart and Vessels / Issue 5/2016
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-015-0654-4

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