Scholars@Duke publication: Comparison of 2-Year Outcomes of Extended Criteria Cardiac Transplantation Versus Destination Left Ventricular Assist Device Therapy Using Continuous Flow.

Comparison of 2-Year Outcomes of Extended Criteria Cardiac Transplantation Versus Destination Left Ventricular Assist Device Therapy Using Continuous Flow.

Publication , Journal Article

Daneshmand, MA; Krishnamoorthy, A; Samsky, MD; Felker, GM; Pura, JA; Lokhnygina, Y; Hernandez, AF; Rosenberg, PB; Blue, LJ; Schroder, JN ...

Published in: Am J Cardiol

August 15, 2015

Published version (DOI) Link to item

Alternatives have emerged for patients ineligible for cardiac transplantation under standard criteria. The purpose of our study was to compare outcomes in patients ineligible for cardiac transplantation under standard criteria, treated either with extended criteria cardiac transplantation (ECCT) or a continuous flow destination therapy left ventricular assist device (CF DT-LVAD). From 2005 to 2012, patients treated with either ECCT or CF DT-LVAD at our institution were retrospectively analyzed. In the overall unmatched cohort, we examined mortality and other outcomes, including index hospitalization length of stay, renal function, stroke, and readmission rates. After propensity score (PS) matching, outcomes were compared between ECCT and CF DT-LVAD recipients. Overall, 62 patients underwent ECCT, and 146 patients were treated with CF DT-LVAD. The 2-year mortality estimate for ECCT recipients was 27.3% (95% confidence interval 15.5% to 39.1%) and for CF DT-LVAD recipients was 11.2% (95% confidence interval 4.8% to 17.6%). After PS matching of 39 patients from each treatment group, there was no significant difference in overall survival after 2 years (p = 0.346). In both unmatched and PS-matched analyses, CF DT-LVAD patients compared with ECCT had a significantly higher estimated glomerular filtration rate at 1 year but also had significantly higher hospital readmission rates. Stroke also more commonly occurred after CF DT-LVAD compared with ECCT (17 vs 5, unmatched; and 2 vs 1, PS matched). However, there was no significant difference between PS-matched groups in 2-year stroke-free survival (p = 0.371). In conclusion, ECCT and CF DT-LVAD in select patients are comparable therapies with respect to 2-year survival.

Duke Scholars

Author Gary Michael Felker Medicine, Cardiology

Author Yuliya Vladimirovna Lokhnygina Biostatistics & Bioinformatics, Division of Biostatistics

Author Adrian Felipe Hernandez Medicine, Cardiology

Author Paul Brian Rosenberg Medicine, Cardiology

Author Jacob Niall Schroder Surgery, Cardiovascular and Thoracic Surgery

Author Carmelo Alessio Milano Surgery, Cardiovascular and Thoracic Surgery

Author Chetan B. Patel Medicine, Cardiology

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Published In

Am J Cardiol

DOI

10.1016/j.amjcard.2015.05.016

EISSN

1879-1913

Publication Date

August 15, 2015

Volume

116

Issue

Start / End Page

573 / 579

Location

United States

Related Subject Headings

Treatment Outcome
Time Factors
Survival Analysis
Stroke
Retrospective Studies
Patient Selection
Middle Aged
Male
Humans
Hospitalization

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Chicago

ICMJE

MLA

NLM

Daneshmand, M. A., Krishnamoorthy, A., Samsky, M. D., Felker, G. M., Pura, J. A., Lokhnygina, Y., … Patel, C. B. (2015). Comparison of 2-Year Outcomes of Extended Criteria Cardiac Transplantation Versus Destination Left Ventricular Assist Device Therapy Using Continuous Flow. Am J Cardiol, 116(4), 573–579. https://doi.org/10.1016/j.amjcard.2015.05.016

Daneshmand, Mani A., Arun Krishnamoorthy, Marc D. Samsky, G Michael Felker, John A. Pura, Yuliya Lokhnygina, Adrian F. Hernandez, et al. “Comparison of 2-Year Outcomes of Extended Criteria Cardiac Transplantation Versus Destination Left Ventricular Assist Device Therapy Using Continuous Flow.” Am J Cardiol 116, no. 4 (August 15, 2015): 573–79. https://doi.org/10.1016/j.amjcard.2015.05.016.

Daneshmand MA, Krishnamoorthy A, Samsky MD, Felker GM, Pura JA, Lokhnygina Y, et al. Comparison of 2-Year Outcomes of Extended Criteria Cardiac Transplantation Versus Destination Left Ventricular Assist Device Therapy Using Continuous Flow. Am J Cardiol. 2015 Aug 15;116(4):573–9.

Daneshmand, Mani A., et al. “Comparison of 2-Year Outcomes of Extended Criteria Cardiac Transplantation Versus Destination Left Ventricular Assist Device Therapy Using Continuous Flow.” Am J Cardiol, vol. 116, no. 4, Aug. 2015, pp. 573–79. Pubmed, doi:10.1016/j.amjcard.2015.05.016.

Daneshmand MA, Krishnamoorthy A, Samsky MD, Felker GM, Pura JA, Lokhnygina Y, Hernandez AF, Rosenberg PB, Blue LJ, Schroder JN, Rogers JG, Milano CA, Patel CB. Comparison of 2-Year Outcomes of Extended Criteria Cardiac Transplantation Versus Destination Left Ventricular Assist Device Therapy Using Continuous Flow. Am J Cardiol. 2015 Aug 15;116(4):573–579.