Impact of risk factors on patient survival with left ventricular assist device implantation as a bridge to orthotopic heart transplant

Though left ventricular assist devices (LVADs) can be life saving, they arc not without complications such as neurologic sequelae, bleeding and thromboembolic events. We wish to evaluate which of the many pre-, intra- and post-operative variables are the most predictive of outcome with LVAD implantation as a bridge to orthotopic heart transplant (OHTX). We retrospectively reviewed records 57 patients with implanted HeartMateO LVADs between 7/92 to 6/00. We performed multivariate logistic regression analysis to assess our data, which included 29 pre-, intra- and post-operative variables. Out of 57 patients, there were 9% African-Americans, 89% Caucasians and 2% Hispanics. There were 21% females and 79% males with average age of 50.8+/-12.1 (range 14 to 68 years) and body surface area of 1.9+/-0.2 (range 1.46 to 2.42 meter(2)). Etiologies of our patient's heart failure included: 58% ischemic, 38% dilated, 2% restrictive and postpartum 2% cardiomyopathies. Forty-five (79%) were fortunate enough to receive OHTX. Our analyses indicate that factors such as peri-operative stroke (p<0.0001), intra-operative bleeding (p<0.0004), LVAD cardiopulmonary bypass time (p<0.0033) and patient age (p<0.028) most strongly affected the long-term outcome post-LVAD implantation.