Cardiac Transplant Surgery
Thomas P. Colletti, DHSc, MPAS, PA-C
Introduction. Left ventricular assist device patients now constitute greater than 50% of cardiac transplantations. Medical management, and surgical difficulty associated with device explantation is different than transplants without such devices.The use of a cardiac donor risk index score to risk stratify donor organs is common; however, it was developed in an era before devices were used as frequently, and when devices were of a previous generation. An increasing proportion of donor organs may be risk stratified by an index that is not applicable to them, and device patient risk may be incorrectly estimated.
Research Question. Is cardiac donor risk index score use predictive, to the same degree in patients with and without left ventricular assist devices, of cardiac transplant primary outcomes of one-, six-, and twelve-month mortality, and secondary outcomes ofintensive care unit and hospitalization length of stay, rejection episodes, and primary graft dysfunction rate?
Design. This is a single-center retrospective database analysis, from March 1, 2015, until January 15, 2018.
Results. Cardiac donor risk indexwas not significantly associated with mortality in patients with and without devices at 6-months and 12-months (p=0.62). Secondary outcomes were not significant, except length of intensive care unit stay (p=0.007, OR 2.815, CI 1.335-5.936) was longer in device patients.
Discussion. Outcomes have more to do with recipient characteristics than donor. VAD explantation does not have the surgical risk it is perceived to. Cardiac donor risk index did not correlate with outcomes in a modern high-volume single center, similar to original published results.
Ledzian BG. A Retrospective Analysis Evaluating Associations Between Cardiac Donor Risk Index Score and Recipient Outcomes in Patients With- and With-Out Intra-Corporeal Left Ventricular Assist Devices. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2019; 1(4).
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