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Does Type of Mechanical Circulatory Support as Bridge to Heart Transplant Affect Outcomes?
Abstracts than 150 msec, irrespective of frequency of aortic valve opening or device speed. Conclusion: Aortic valve opening time is a novel characterization of the aortic valve in patients with continuous flow devices, independent of frequency of aortic valve opening. The relationship between the AVOT and outcomes needs to be defined.
1164 Does Type of Mechanical Circulatory Support as Bridge to Heart Transplant Affect Outcomes? F. Hussain,1 J. Newman,2 H. Basha,2 S. Morris,1 A. Waqar,1 A. Heroux,2 E. McGee,3 E. Raichlin,2 and M. Liebo.2 1Internal Medicine, Loyola University Medical Center, Maywood, IL; 2Cardiology, Loyola University Medical Center, Maywood, IL; and the 3Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL. Purpose: Bridge to transplant (BTT) with left ventricular assist device (LVAD) is associated with repeat sternotomy, risk of adverse events, and allosensitization. Consequently intra-aortic balloon pump (IABPs) have been increasingly used as BTT despite a paucity of data comparing the two strategies. We aim to compare pre- and post- heart transplant (HTx) outcomes in patients supported by LVAD and IABP as BTT. Methods: This retrospective cohort study included all patients BTT by LVAD (n=115) and IABP (n=32) at a single medical center between 7/ 2010 and 4/2018. Results: Twenty-three (20%) patients bridged with LVAD and 3 (9%) bridged with IABP died on the waiting list (p=0.03), whereas 83 (72%) LVAD patients and 23 (72%) IABP patients underwent HTx after 373 (median, IQR 184;743) and 18 (12;31) days of support, respectively. Six (19%) patients with IABP crossed over to LVAD. Patients BTT with LVAD had higher weight (86.3 +/- 20.5 vs 77.7 +/- 16.5, p=0.05) and albumin (3.7 +/- 1.5 vs 2.9 +/- 0.5, p<0.01) and lower creatinine (1.5 +/- 0.6 vs 1.8 +/- 0.9, p=0.04) at the time of HTx; however, incidence of renal failure requiring dialysis (23 [11%] vs 2 [9%], p=0.8) and creatinine at 1 year post-HTx (1.8 +/- 1.6 vs 1.7 +/- 1.5, p=0.6) did not differ between groups. Post-HTx length of hospital stay was significantly longer in IABP patients (46 [33, 71] vs 21 [15, 32] days, p<0.001). IABP was associated with lower one-year post-HTx rejection scores (0.31 +/- 0.26 vs 0.52 +/- 0.34, p=0.01), though one-year post-HTx survival did not differ between strategies (Figure 1). Conclusion: BTT with IABP compared to LVAD was associated with longer post-HTx hospital stay, lower rejection score, similar renal function, and similar short-term survival. Additional studies are needed to compare these two strategies with respect to patient outcomes as well as overall cost effectiveness.
S461 1165 Measurement of Frailty over Time in Ventricular Assist Device Patients: Use of the 5-Meter Walk Test S.E. Schroeder,1 W.S. Alonso,2 J.A. Steuter,3 and B.J. Pozehl.4 1MCS Team, Cardiothoracic Surgery, Bryan Heart, Lincoln, NE; 2College of Nursing, Post-Doctoral Research Associate, University of Nebraska Medical Center, Omaha, NE; 3Division of Cardiology, Bryan Heart, Lincoln, NE; and the 4Department of Nursing/Cardiology, University of Nebraska Medical Center, Omaha, NE. Purpose: Frailty remains ill-defined in the literature with more than 20 different methods and instruments available for assessment. The 5-Meter Walk Test (5MWT) has been utilized in the cardiac surgical population with a cut-off of 6 seconds for gait speed to differentiate between frail and non-frail individuals. This study aimed to describe frailty in the Ventricular Assist Device (VAD) population using the 5MWT at baseline (preimplant) and over time post-implant, and to compare differences in length of stay (LOS), Intermacs scores, intubation times, and quality of life (QOL) between frail and non-frail patients. Methods: Retrospective data was obtained on patients implanted with a VAD between September 2012 and September 2018. Patients completed a 5MWT and the EQ5D Visual Analog Scale to measure QOL prior to VAD and again at post-implant 1, 3, 6, and 12 month visits. Descriptive statistics, dependent t-tests (examining frailty over time), independent t-tests (comparing frail and non-frail) and Spearman correlations were used to analyze the data. Results: The sample (N=21) was 67% male, 38% with ischemic cardiomyopathy (n=8), and an average age of 64.3 +/-12 years. Significant improvement in mean 5MWT scores occurred from pre-implant to 3 months post-implant [pre-implant 5MWT: 7.98 +/- 5.02 seconds; 3-month post-implant: 4.90 +/- 1.54 seconds; t (df=15) = 2.94, p=0.01]. Preimplant 5MWT scores demonstrated 13 of 21 patients were frail. Although not significant, frail patients had longer LOS (frail: 20.08 +/8.60 days; non-frail: 14.88 +/- 5.77 days) and intubation times (frail: 66.6 +/- 61.4 hours; non-frail: 48.7 +/- 58.2 hours) compared to non-frail counterparts. Negative correlations were found between pre-implant 5MWT and Intermacs scores (r=-.50, p=0.02) and pre-implant 5MWT and QOL (r=-0.63, p=0.004). Conclusion: 5MWTs are sensitive to change from pre- to post-implant in VAD patients. The most significant 5MWT improvements with VAD therapy were seen at 3 months post-implant. Frail patients had longer LOS and intubation times compared to the non-frail patients. The 5MWT may be a simple and clinically relevant assessment of frailty for VAD patients that relates to post-implant outcomes, however additional research with a larger sample is needed. 1166 REMEDIZER- An Innovative Program of Remote Home Care for Patients with Implanted Mechanical Heart Support. Single Centre Experience J. Szymanski,1 A. Juraszek,1 M. Jasinska,2 M. Sobieszczanska-Ma»ek,3 T. Zielinski,3 and M. Kusmierczyk.1 1Department of Cardiac Surgery and Transplantation, Warsaw Institute of Cardiology, Warsaw, Poland; 2 Department of Anesthesia, Warsaw Institute of Cardiology, Warsaw, Poland; and the 3Department of Cardiac Failure and Transplantation, Warsaw Institute of Cardiology, Warsaw, Poland.
Figure 1 Survival following heart transplantation dichotomized by bridging support therapy.
Purpose: To evaluate our single centre experience with REMEDIZER. This locally developed application is used to monitor patients with implanted heart assist pumps (LVAD, Left Ventricular Assist Device) after completed initial hospitalization. Methods: REMEDIZER is an web and mobile based application. LVAD patients log there every day and store clinical data. Following data is saved: blood pressure, heart rate, body temperature, fluid intake and output, LVAD pump speed, flow, pulsatility index and power. Additionally, the patients store their clinical symptoms and introduce current drugs by
1164 Does Type of Mechanical Circulatory Support as Bridge to Heart Transplant Affect Outcomes? F. Hussain,1 J. Newman,2 H. Basha,2 S. Morris,1 A. Waqar,1 A. Heroux,2 E. McGee,3 E. Raichlin,2 and M. Liebo.2 1Internal Medicine, Loyola University Medical Center, Maywood, IL; 2Cardiology, Loyola University Medical Center, Maywood, IL; and the 3Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL. Purpose: Bridge to transplant (BTT) with left ventricular assist device (LVAD) is associated with repeat sternotomy, risk of adverse events, and allosensitization. Consequently intra-aortic balloon pump (IABPs) have been increasingly used as BTT despite a paucity of data comparing the two strategies. We aim to compare pre- and post- heart transplant (HTx) outcomes in patients supported by LVAD and IABP as BTT. Methods: This retrospective cohort study included all patients BTT by LVAD (n=115) and IABP (n=32) at a single medical center between 7/ 2010 and 4/2018. Results: Twenty-three (20%) patients bridged with LVAD and 3 (9%) bridged with IABP died on the waiting list (p=0.03), whereas 83 (72%) LVAD patients and 23 (72%) IABP patients underwent HTx after 373 (median, IQR 184;743) and 18 (12;31) days of support, respectively. Six (19%) patients with IABP crossed over to LVAD. Patients BTT with LVAD had higher weight (86.3 +/- 20.5 vs 77.7 +/- 16.5, p=0.05) and albumin (3.7 +/- 1.5 vs 2.9 +/- 0.5, p<0.01) and lower creatinine (1.5 +/- 0.6 vs 1.8 +/- 0.9, p=0.04) at the time of HTx; however, incidence of renal failure requiring dialysis (23 [11%] vs 2 [9%], p=0.8) and creatinine at 1 year post-HTx (1.8 +/- 1.6 vs 1.7 +/- 1.5, p=0.6) did not differ between groups. Post-HTx length of hospital stay was significantly longer in IABP patients (46 [33, 71] vs 21 [15, 32] days, p<0.001). IABP was associated with lower one-year post-HTx rejection scores (0.31 +/- 0.26 vs 0.52 +/- 0.34, p=0.01), though one-year post-HTx survival did not differ between strategies (Figure 1). Conclusion: BTT with IABP compared to LVAD was associated with longer post-HTx hospital stay, lower rejection score, similar renal function, and similar short-term survival. Additional studies are needed to compare these two strategies with respect to patient outcomes as well as overall cost effectiveness.
S461 1165 Measurement of Frailty over Time in Ventricular Assist Device Patients: Use of the 5-Meter Walk Test S.E. Schroeder,1 W.S. Alonso,2 J.A. Steuter,3 and B.J. Pozehl.4 1MCS Team, Cardiothoracic Surgery, Bryan Heart, Lincoln, NE; 2College of Nursing, Post-Doctoral Research Associate, University of Nebraska Medical Center, Omaha, NE; 3Division of Cardiology, Bryan Heart, Lincoln, NE; and the 4Department of Nursing/Cardiology, University of Nebraska Medical Center, Omaha, NE. Purpose: Frailty remains ill-defined in the literature with more than 20 different methods and instruments available for assessment. The 5-Meter Walk Test (5MWT) has been utilized in the cardiac surgical population with a cut-off of 6 seconds for gait speed to differentiate between frail and non-frail individuals. This study aimed to describe frailty in the Ventricular Assist Device (VAD) population using the 5MWT at baseline (preimplant) and over time post-implant, and to compare differences in length of stay (LOS), Intermacs scores, intubation times, and quality of life (QOL) between frail and non-frail patients. Methods: Retrospective data was obtained on patients implanted with a VAD between September 2012 and September 2018. Patients completed a 5MWT and the EQ5D Visual Analog Scale to measure QOL prior to VAD and again at post-implant 1, 3, 6, and 12 month visits. Descriptive statistics, dependent t-tests (examining frailty over time), independent t-tests (comparing frail and non-frail) and Spearman correlations were used to analyze the data. Results: The sample (N=21) was 67% male, 38% with ischemic cardiomyopathy (n=8), and an average age of 64.3 +/-12 years. Significant improvement in mean 5MWT scores occurred from pre-implant to 3 months post-implant [pre-implant 5MWT: 7.98 +/- 5.02 seconds; 3-month post-implant: 4.90 +/- 1.54 seconds; t (df=15) = 2.94, p=0.01]. Preimplant 5MWT scores demonstrated 13 of 21 patients were frail. Although not significant, frail patients had longer LOS (frail: 20.08 +/8.60 days; non-frail: 14.88 +/- 5.77 days) and intubation times (frail: 66.6 +/- 61.4 hours; non-frail: 48.7 +/- 58.2 hours) compared to non-frail counterparts. Negative correlations were found between pre-implant 5MWT and Intermacs scores (r=-.50, p=0.02) and pre-implant 5MWT and QOL (r=-0.63, p=0.004). Conclusion: 5MWTs are sensitive to change from pre- to post-implant in VAD patients. The most significant 5MWT improvements with VAD therapy were seen at 3 months post-implant. Frail patients had longer LOS and intubation times compared to the non-frail patients. The 5MWT may be a simple and clinically relevant assessment of frailty for VAD patients that relates to post-implant outcomes, however additional research with a larger sample is needed. 1166 REMEDIZER- An Innovative Program of Remote Home Care for Patients with Implanted Mechanical Heart Support. Single Centre Experience J. Szymanski,1 A. Juraszek,1 M. Jasinska,2 M. Sobieszczanska-Ma»ek,3 T. Zielinski,3 and M. Kusmierczyk.1 1Department of Cardiac Surgery and Transplantation, Warsaw Institute of Cardiology, Warsaw, Poland; 2 Department of Anesthesia, Warsaw Institute of Cardiology, Warsaw, Poland; and the 3Department of Cardiac Failure and Transplantation, Warsaw Institute of Cardiology, Warsaw, Poland.
Figure 1 Survival following heart transplantation dichotomized by bridging support therapy.
Purpose: To evaluate our single centre experience with REMEDIZER. This locally developed application is used to monitor patients with implanted heart assist pumps (LVAD, Left Ventricular Assist Device) after completed initial hospitalization. Methods: REMEDIZER is an web and mobile based application. LVAD patients log there every day and store clinical data. Following data is saved: blood pressure, heart rate, body temperature, fluid intake and output, LVAD pump speed, flow, pulsatility index and power. Additionally, the patients store their clinical symptoms and introduce current drugs by