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Risk of dnDSA with Various MCS Devices as Bridge-to-Transplant
Abstracts 200 A Comparison of Middle Cerebral Artery and Central Retinal Artery Hemodynamics in HM II Patients E.J. Stöhr,1 R. Ji,2 K. Akiyama,3 F. Castagna,2 A. Pinsino,2 J.R. Cockcroft,1 M. Yuzefpolskaya,2 A.R. Garan,2 V.K. Topkara,2 R.T. Te-Frey,3 H. Takayama,3 K. Takeda,3 Y. Naka,3 P.C. Colombo,2 J.Z. Willey,4 and B.J. McDonnell.1 1Physiology & Health, Cardiff Metropolitan University, Cardiff, United Kingdom; 2Medicine, Columbia University Medical Center, New York, NY; 3Cardiothoracic Surgery, Columbia University Medical Center, New York, NY; and the 4Neurology Stroke, Columbia University Medical Center, New York, NY. Purpose: In the normal, pulsatile circulation, the hemodynamic pattern of the middle cerebral artery (MCA) differs from the central retinal artery (CRA). Whether continuous flow from a left ventricular assist device (LVAD) alters this relationship is not known. Since serious adverse events in different end-organs, such as stroke and GI bleeding, are frequent in LVAD patients, comparing hemodynamics in different arterial beds may enhance our understanding of the specific pathophysiology of these complications. Hypothesis: Because of continuous flow, hemodynamic patterns between the MCA and CRA are more similar in HeartMate II (HM II) patients compared with healthy individuals. Methods: MCA and CRA time-averaged maximal flow velocity (TAMAX), pulsatility index (PI) and resistance index (RI) were determined using Doppler ultrasound with angle correction, in 20 HM II pts and 21 healthy individuals. To test the study hypothesis, data were statistically analysed for both group differences and group variances. Results: Although PI and RI were markedly lower in HM II patients in both the MCA and CRA (P < 0.003), TAMAX was significantly lower only in the MCA. Similarly, the variance (range) of scores was inconsistent between groups (Fig. 1 & 2). Conclusion: The typical differences that are observed in small- and microcirculatory hemodynamics of healthy individuals are altered in HM II patients. Notably, the wide ranges of haemodynamics observed in the HM II group may carry important implications with respect to the pathophysiology of specific end-organ complications, and, eventually, the identification of high-risk patients.
201 Risk of dnDSA with Various MCS Devices as Bridge-to-Transplant R.T. Cole,1 M. Flattery,2 J. Minto,3 A. Parikh,4 T. Dong,1 R. Roy,1 L. Bogar,5 A. Smith,1 J. Vega,1 A. Morris,1 S. Laskar,6 K. Bhatt,1 D. Gupta,1 A. Lala,7 K. Shah,8 and P. Shah.9 1Cardiology, Emory Univ Sch of Med, Atlanta, GA; 2Cardiology, Virginia Commonwealth University,
S91 Richmond, VA; 3George Washington University School of Medicine, Washington, D.C., DC; 4Cardiology, Mount Sinai Hospital, New York, NY; 5 Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, VA; 6Cardiology, Emory University School of Medicine, Atlanta, GA; 7Mount Sinai Hospital, New York, NY; 8Virginia Commonwealth University, Richmond, VA; and the 9Inova Heart and Vascular Institute, Falls Church, VA. Purpose: Previous reports have suggested an association between pretransplant mechanical circulatory support (MCS) and an increased risk for post-transplant de novo donor specific antibodies (dnDSA). However, it is unclear if specific MCS devices pose a greater risk for dnDSA. The present study seeks to better understand the risk of dnDSA posed by a variety of MCS devices in a multicenter, collaborative study. Methods: Multicenter, retrospective analysis of 319 heart transplant recipients from 4 U.S. centers between 2011 - 2017. The primary outcome was the development of post-transplant dnDSA. Results: 145 of 319 (45%) patients were supported with durable MCS devices prior to transplant, including 47 Heartware (HVAD), 73 Heartmate II (HM2), and 25 total artificial hearts (TAH). MCS patients had a higher risk of dnDSA compared to those transplanted without mechanical support (37% vs. 23%, p = 0.006; Kaplan Meier log rank p < 0.001, Figure 1). No significant differences were seen between the devices in the risk of dnDSA (Heartware 36%, Heartmate II 38%, and TAH 32%, p = 0.848). However, when compared to patients transplanted without MCS support, patients bridged with HVAD and HM2 devices had higher risk for dnDSA, whereas no difference was seen between TAH to no MCS (Figure 2). Conclusion: Pre-transplant MCS is associated with higher risk for dnDSA. Similar risk is seen regardless of device type; however, the risk associated with TAH was not significantly increased compared to no MCS.
201 Risk of dnDSA with Various MCS Devices as Bridge-to-Transplant R.T. Cole,1 M. Flattery,2 J. Minto,3 A. Parikh,4 T. Dong,1 R. Roy,1 L. Bogar,5 A. Smith,1 J. Vega,1 A. Morris,1 S. Laskar,6 K. Bhatt,1 D. Gupta,1 A. Lala,7 K. Shah,8 and P. Shah.9 1Cardiology, Emory Univ Sch of Med, Atlanta, GA; 2Cardiology, Virginia Commonwealth University,
S91 Richmond, VA; 3George Washington University School of Medicine, Washington, D.C., DC; 4Cardiology, Mount Sinai Hospital, New York, NY; 5 Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, VA; 6Cardiology, Emory University School of Medicine, Atlanta, GA; 7Mount Sinai Hospital, New York, NY; 8Virginia Commonwealth University, Richmond, VA; and the 9Inova Heart and Vascular Institute, Falls Church, VA. Purpose: Previous reports have suggested an association between pretransplant mechanical circulatory support (MCS) and an increased risk for post-transplant de novo donor specific antibodies (dnDSA). However, it is unclear if specific MCS devices pose a greater risk for dnDSA. The present study seeks to better understand the risk of dnDSA posed by a variety of MCS devices in a multicenter, collaborative study. Methods: Multicenter, retrospective analysis of 319 heart transplant recipients from 4 U.S. centers between 2011 - 2017. The primary outcome was the development of post-transplant dnDSA. Results: 145 of 319 (45%) patients were supported with durable MCS devices prior to transplant, including 47 Heartware (HVAD), 73 Heartmate II (HM2), and 25 total artificial hearts (TAH). MCS patients had a higher risk of dnDSA compared to those transplanted without mechanical support (37% vs. 23%, p = 0.006; Kaplan Meier log rank p < 0.001, Figure 1). No significant differences were seen between the devices in the risk of dnDSA (Heartware 36%, Heartmate II 38%, and TAH 32%, p = 0.848). However, when compared to patients transplanted without MCS support, patients bridged with HVAD and HM2 devices had higher risk for dnDSA, whereas no difference was seen between TAH to no MCS (Figure 2). Conclusion: Pre-transplant MCS is associated with higher risk for dnDSA. Similar risk is seen regardless of device type; however, the risk associated with TAH was not significantly increased compared to no MCS.