Clinical Outcomes for INTERMACS Profile 1 Patient Implanted with the Total Artificial Heart
K.B. Shah, K.L. Thanavaro, D.G. Tang, V. Kasirajan. Division of Cardiology, Virginia Commonwealth University, Richmond; Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond
Purpose: The total artificial heart (TAH) is an effective bridge to heart transplantation (HT) for patients (pts) with refractory heart failure. Clinical risks factors for survival on the TAH differ from those in pts with LVADs. While INTERMACS Profile 1 pts are at highest risk for mortality after LVAD implantation, data defining risk by INTERMACS Profile for TAH pts are lacking.
Methods and Materials: We conducted a single-center retrospective study of 66 consecutive pts who received the TAH from 2006-2012. Pts were compared by INTERMACS Profile 1 vs Profiles 2-4. The baseline characteristics and laboratory values of pts in each group were analyzed with a chi-squares and t-test. Death on device was analyzed by Kaplan-Meier and Cox regression analysis.
Results: Twenty-seven of the 67 (40%) pts were Profile 1. Both groups were similar age, race and gender. Profile 1 pts had lower hemoglobin (10.0±2.0 vs 11.1±1.8 g/dL, P=0.02), higher alanine aminotransferase levels (582±1121 vs 44±31 u/L, P=0.02), increased INR (1.5±0.5 vs 1.3±0.4 u/L, P=0.04), and more frequent history of ischemic heart disease (33 vs 13%, P=0.045). Preoperatively, they were more likely to require mechanical ventilation (44 vs 0%, P<0.001), hemodialysis (37 vs 3%, P<0.001), ECMO (22 vs 0%, P=0.002), and VAD therapy (26 vs 0%, P< 0.001). After surgery, Profile 1 pts were more likely to return to the OR for bleeding (59 vs 24%, P=0.004) and had a decreased survival (74% vs 95%, P=0.019; HR(CI): 5.3(1.1-25.7), P=0.04).
Conclusions: INTERMACS Profile 1 TAH pts had decreased survival after device implantation compared to Profiles 2-4. The outcomes were however favorable when compared to registry and multicenter data describing outcomes for high risk patients for LVAD and Bi-VAD therapy.
Session: Poster Session 2: Mechanical Circulatory Support (10:00 AM-6:30 PM)
Date/Time: Thursday, April 25, 2013 - 5:30 PM