Pre-Operative Right Ventricular Dysfunction is Not Predictive of Gastrointestinal Bleeding in Patients Supported by Continuous-Flow Left Ventricular Assist Devices

The 21st Annual Scientific Meeting intra-aortic balloon pump and 85% (n = 29) were requiring vasopressor/inotrope therapy prior to Impella placement. The Impella 2.5, CP, and 5.0 were used in 41% (n = 14), 35% (n = 12) and 24% (n = 8) respectively. Impella support was used for a mean duration of 90.56 ± 74.26 hours. Mean left ventricular ejection fraction improved from admission to discharge (18 ± 10 vs 37 ± 20%, P = .001). In-hospital mortality was 38% (n = 13), 47% (n = 16) of patients were discharged alive with 94% recovering without need for further device therapy (Figure). Conclusions: This is the largest analysis of Impella-supported myocarditis cases to date. The use of the Impella appears to be safe and effective in the settings of myocarditis complicated by cardiogenic shock.

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HFSA

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Table 2. Pre-Operative RV Dysfunction as a Predictor of Readmission for GIB

Pre-op RV dysfunction (Yes vs. No)

OR (95% CI)

p

.60 (.24–1.49)

.27

Note: N = 162. Significance determined using logistic regression model.

Further studies are needed to determine whether RV dysfunction plays a role in the development of GIB.

369 Influence of Donor Sex and Mode of Death on Cardiac Allograft Recipients: A Pilot Study M. Beth Hammond1, Scott D. Goddard2, Chuck Zollinger3, Scott McDonald3, Jacob Young3, Josef Stehlik4, Abdallah G. Kfoury5, M. Elizabeth H. Hammond5; 1West Valley High School, Fairbanks, Alaska; 2University of Alaska at Fairbanks, Fairbanks, Alaska; 3 Intermountain Donor Services, Salt Lake City, Utah; 4University of Utah Medical Center, Salt Lake City, Utah; 5Intermountain Medical Center, Salt Lake City, Utah

368 Pre-Operative Right Ventricular Dysfunction is Not Predictive of Gastrointestinal Bleeding in Patients Supported by Continuous-Flow Left Ventricular Assist Devices Matthew Stegman, Neelam Balasubramanian, Max Liebo; Loyola University Medical Center, Maywood, Illinois Background: Gastrointestinal bleed (GIB) is a common complication of continuousflow left ventricular assist device (CF-LVAD) support and a significant source of morbidity related to hospitalization, need for invasive intervention, increased risk for pump thrombosis due to interruptions in anticoagulation, and overall reduced quality of life. A recent study suggested that right ventricular (RV) dysfunction identified on pre-operative echocardiography is predictive of GIB; however, this finding has not been corroborated by hemodynamic assessment of RV function. Methods: This is a retrospective chart review of 164 patients implanted with CF-LVADs at a single university medical center between 2009 and 2016. Patient data from pre-operative right heart catheterization (RHC) and post-implant clinical course were collected from the institution’s EMR. RV dysfunction was defined as having at least two of the following parameters: right ventricular stroke work index (RVSWI) < 450; central venous pressure/ pulmonary capillary wedge pressure ratio (CVP/PCWP) > 0.6, pulmonary artery pulsatility index (PAPi) < 1.85. Patients were deemed to have a GIB if admitted to the hospital with a decrease in baseline hemoglobin and presence of any of the following: positive fecal occult blood; hematochezia; positive findings on enteroscopy or colonoscopy. A logistic regression model was used to determine whether RV dysfunction increased the odds of readmission for GIB. Results: Approximately 21% (34/164) of patients in the cohort developed at least one episode of GIB requiring readmission. There were no significant associations between any of the individual parameters obtained from preoperative RHC and GIB (Table 1). Likewise there was no significant association between pre-operative RV dysfunction and GIB (OR 0.60 [0.24–1.49]) (Table 2). Conclusion: We found no significant association between RV dysfunction as defined by hemodynamic criteria and GIB in our CF-LVAD cohort. These findings run contrary to the prior study that demonstrated a significant association using echocardiographic data.

Introduction: Emerging data indicate that both donor and recipient innate immune responses participate in initiating and accelerating adaptive immune responses. Hypoxia is the primary stimulus for elaboration of reactive oxygen species (ROS). ROS activates the innate immune systems of the donor and the recipient which unleashes a systemic inflammatory state. We hypothesized that the donor deaths with prolonged hypoxia and inflammatory stress would result in recipient cardiac injury and allograft loss. Methods: We obtained an extract of donor records from Intermountain Donor Services. We linked donor records to recipients in the UTAH Cardiac Transplant Database. We extracted donor records most disparate with respect to donor hypoxic injury: donors dying of gun-shot wounds (GSW) and donors dying in motor vehicle accidents (MVA). We linked donor records to the outcome of transplant recipients. Deaths were classified as cardiovascular (CV) deaths based on United Network for Organ Sharing (UNOS) criteria. We compared the frequency of CV deaths in the two groups of donors using Fisher’s Exact Test. In multivariate analysis, we found interaction between donor sex and CV death, so we also compared the frequency of CV death in both male and female donors. Finally, we compared the frequency of CV death of recipients who received a heart from a donor who was both female and died in an MVA. Results: Our hypothesis was confirmed that recipients receiving MVA donor hearts were more likely to experience CV death (Fisher’s Exact Test, P = .023, OR = 4.05). We unexpectedly found that recipients receiving female donor hearts had a higher rate of CV death (Fisher’s Exact Test, P = .021, OR = 1.74). We found that recipients who received hearts from donors who were both female and died in an MVA when compared to all others, had an even stronger relationship with CV death (Fisher’s Exact Test, P = .00003, OR = 31.27). Conclusions: This study, though based on data from a single institution, suggests that donor causes of death with greater innate immune stimulation, result in higher risk of CV death. Surprisingly, donor sex is also associated with increased CV death of recipients, regardless of their gender. Stacking female donor and MVA death resulted in synergistic increase in the risk of CV death in the recipient. A validation study using UNOS data is planned.

Table 1. Pre-Operative RHC Variables by Readmission for GIB

HR CVP SPA DPA MPAP PCWP SVO2 CO CI RVSWI PAPi CVP/PCWP On Inotropes No Yes

No GIB (N = 131)

GIB (N = 34)

p

84.01 (21.31) 12.06 (6.61) 52.23 (15.51) 25.97 (8.45) 36.19 (10.08) 24.91 (8.95) 53.50 (11.67) 4.10 (1.34) 2.02 (0.60) 606.75 (287.9) 3.11 (4.11) 0.48 (0.22)

77.76 (17.80) 12.97 (6.05) 56.62 (13.76) 26.71 (7.90) 38.06 (9.75) 25.74 (8.63) 51.71 (10.56) 3.97 (0.93) 1.89 (0.40) 601.63 (157.38) 3.30 (3.16) 0.51 (0.21)

.12a .48a .14a .65a .34a .63a .42a .59a .26a .89b .81a .47a .28c

80 (61%) 52 (39%)

24 (71%) 10 (29%)

Note: N = 164. Significance determined using aIndependent samples t-test with equal variances assumed, bIndependent samples t-test with equal variances not assumed, cPearson Chi-Square test.

370 Simultaneous Heart-Liver or Isolated Heart Transplantation for Patients with Heart Failure and Liver Disease Saurav Uppal1, Haytham Mously1, Mohammed Wazzan1, Sadeer Al-Kindi2, Monique Robinson2; 1University Hospitals Cleveland Medical Center, Cleveland, Ohio; 2University Hospitals Cleveland Medical Center Harrington Heart and Vascular Institute, Cleveland, Ohio Background: Combined Heart-Liver Transplantation has emerged as a good option in selected patients with end stage heart and liver disease. However, some patients have progressive heart failure while awaiting dual-organ transplantation necessitating isolated heart transplantation. The outcome of such approach is largely unknown. Methods: We reviewed all adult patients listed for heart-liver transplantation in the UNOS registry between 1987 and 2015. Patients were divided by the transplanted organ into heart only (HT) and heart-liver simultaneous transplantations (HLT). Comparative and survival analyses were performed. Results: We identified a total of 219 patients listed for HLT. Of those, 185 (84.5%) received HLT and 34 received HT. Median age 50 [39– 58] years, 159 (73%) were male, 153 (70%) were white. Median total bilirubin was 1