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Severity of End Organ Damage as a Predictor of Outcomes after Implantation of Continuous Flow Left Ventricular Assist Devices (LVAD)
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The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2013
Results: Out of as total of more than 1200 double/single lung transplantations during the period of analysis, one single and 17 bilateral lung transplants were performed in 18 patients with LAM. All patients were women with a mean age of 50 ⫾ 9 years. The mean cold ischemia time was 376,5 ⫾ 136,5 minutes. Thirty-day survival was 100%. Four late deaths occurred due to chronic graft dysfunction, sepsis, airway stenosis (1) and CMV pneumonitis. The actuarial survival in the LAM group was 92% at 1 year, 69% at 3 years and 69% at 5 years compared to an overall survival of 77%, 69% and 61% after LTx for other indications. Conclusions: LTx in patients with end-stage pulmonary LAM yields equivalent or better results to patients with lung transplantation for other indications. While there are no prospective data on survival in LAM patients, lung transplantation improves quality of life and probably also increases survival in patients with end-stage LAM. The results justify transplantation and offer a valuable therapy for patients with end-stage pulmonary LAM.
dysfunction as determined by the sequential organ failure assessment (SOFA) score is a determinant of outcomes after LVAD implantation. Methods and Materials: We determined the pre-operative SOFA score and short and long-term outcomes of 97 consecutive patients who received Heartmate II (HMII) or Heartware (HW) LVAD at our institution since January 2007. The performance of the score in predicting outcomes was evaluated using receiver operating characteristic (ROC) analysis. Kaplan-Meier analysis was used to compare long term survival across SOFA score sub-groups. Results: v 18⫾10 days, p¼0.03). One year survival for SOFA scores 0-2, 3-5, 6-8 and Z9 was 94%, 75%, 64% and 29% respectively. SOFA score was significantly lower in survivors at 6, 9,12, 24, and 36 months. SOFA score did not predict adverse outcomes of bleeding, cerebrovascular events, infection or pump exchange.
606 C1-Esterase-Inhibitor Counteracts Severe Primary Graft Dysfunction in Lung Transplantation W. Sommer,1 I. Tudorache,1 C. Kuhn, ¨ 1 M. Avsar,1 J. Gottlieb,2 A. Haverich,1 G. Warnecke.1 1Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany; 2Department of Pneumology, Hannover Medical School, Hannover, Germany. Purpose: Primary Graft Dysfunction(PGD)in Lung Transplantation (LTX) occurs in 8-20% of all LTX and usually is combined with increased morbidity and mortality of 30-40%. A deficit of C1-INH presents a clinical picture of severe capillary leakage. Therefore, we hypothesized that application of C1-INH in LTX recipients that show first signs of severe ischemia-reperfusion injury attenuates PGD. Methods and Materials: All LTX recipients that showed low oxygenation indices (o100 mmHg/FiO2) at the end of surgery while still in the operating theatre, were immediately treated with 1000 IE of C1-INH starting as of 05/2010. Postoperative data of all LTX recipients since that date were collected and analyzed. Results: A total of 296 LTX were performed between May 2010 and September 2012 at our centre. Out of this, 24 patients (8.11%) developed a low oxygenation index at the end of surgery (mean 85.46 mmHg) and were treated with C1-INH. The PGD Score (ISHLT) was significantly higher in the C1-INH treated group directly postoperatively, 24 hours, 48 hours and 72 hours postoperatively (T0 2.42⫾0.21vs. 0,74⫾0.06, po0.0001; T24 1.79⫾0.17 vs. 0.73⫾0.05, po0.0001; T48 1.88⫾0.17 vs. 0.70⫾0.05, po0.0001; T72 1.66⫾0.17 vs. 0.66⫾0.05, po0.0001). Patients treated with C1-INH had a significantly longer ICU stay compared to other LTX patients (days 15.92⫾3,74 vs. 4.04⫾0.27 days, po0.0001), but ventilation time and hospital stay were not significantly longer. Out of the 24 patients being treated with C1-INH, 3 died due to a PGD-related cause. One-year-survival in the C1-INH group was lower compared to the patients without PGD and C1-INH (83.33% vs. 93.01%, p¼0.03), but was still in a favourable range. Conclusions: PGD is a serious complication after LTX, but treatment with C1-INH led to acceptable morbidity and mortality. Although survival in the C1-INH treated patients was lower than in the remaining collective, it was effectively as good or better as what is internationally regarded as reasonable outcome after LTX in general (483% one-year-survival). 607 Severity of End Organ Damage as a Predictor of Outcomes after Implantation of Continuous Flow Left Ventricular Assist Devices (LVAD) Z.C. Landis, B. Soleimani, E.R. Stephenson, A. El-Banayosy, W.E. Pae. Heart and Vascular Institute, Penn State Hershey Medical Center, Hershey, PA. Purpose: The optimal timing of implantation of LVAD in management of advanced heart failure remains controversial. We hypothesize that in patients with cardiogenic shock, the severity of end-organ
Conclusions: These results show that pre-operative SOFA score is a powerful predictor of outcomes after LVAD implantation. Long-term outcomes of patients with advanced heart failure treated with LVAD can be significantly improved by early intervention prior to emergence of end-organ dysfunction. 608 Overall Outcomes of Patients with Left Ventricular Assist Devices (LVADs) in Acute Rehabilitation Facility: How Safe Are These Patients at Rehabilitation Facilities? K.C. McCants, P.S. Combs, P. Raheja, S. Rhode, K. Vessels, A. Lenneman, E. Birks. Advanced Heart Failure, University of Louisville & Jewish Hospital, Louisville, KY. Purpose: Patients (pts) with LVADs are challenging with issues relating to transition of care and reducing hospital length of stay. However, in severely debilitated patients this can involve transitioning to long term care facilities, subacute and acute rehabilitation facilities. Currently, there are few centers that accept patients with LVADs which indirectly affect hospital length of stay (LOS). We report the outcomes including:
The Journal of Heart and Lung Transplantation, Vol 32, No 4S, April 2013
Results: Out of as total of more than 1200 double/single lung transplantations during the period of analysis, one single and 17 bilateral lung transplants were performed in 18 patients with LAM. All patients were women with a mean age of 50 ⫾ 9 years. The mean cold ischemia time was 376,5 ⫾ 136,5 minutes. Thirty-day survival was 100%. Four late deaths occurred due to chronic graft dysfunction, sepsis, airway stenosis (1) and CMV pneumonitis. The actuarial survival in the LAM group was 92% at 1 year, 69% at 3 years and 69% at 5 years compared to an overall survival of 77%, 69% and 61% after LTx for other indications. Conclusions: LTx in patients with end-stage pulmonary LAM yields equivalent or better results to patients with lung transplantation for other indications. While there are no prospective data on survival in LAM patients, lung transplantation improves quality of life and probably also increases survival in patients with end-stage LAM. The results justify transplantation and offer a valuable therapy for patients with end-stage pulmonary LAM.
dysfunction as determined by the sequential organ failure assessment (SOFA) score is a determinant of outcomes after LVAD implantation. Methods and Materials: We determined the pre-operative SOFA score and short and long-term outcomes of 97 consecutive patients who received Heartmate II (HMII) or Heartware (HW) LVAD at our institution since January 2007. The performance of the score in predicting outcomes was evaluated using receiver operating characteristic (ROC) analysis. Kaplan-Meier analysis was used to compare long term survival across SOFA score sub-groups. Results: v 18⫾10 days, p¼0.03). One year survival for SOFA scores 0-2, 3-5, 6-8 and Z9 was 94%, 75%, 64% and 29% respectively. SOFA score was significantly lower in survivors at 6, 9,12, 24, and 36 months. SOFA score did not predict adverse outcomes of bleeding, cerebrovascular events, infection or pump exchange.
606 C1-Esterase-Inhibitor Counteracts Severe Primary Graft Dysfunction in Lung Transplantation W. Sommer,1 I. Tudorache,1 C. Kuhn, ¨ 1 M. Avsar,1 J. Gottlieb,2 A. Haverich,1 G. Warnecke.1 1Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany; 2Department of Pneumology, Hannover Medical School, Hannover, Germany. Purpose: Primary Graft Dysfunction(PGD)in Lung Transplantation (LTX) occurs in 8-20% of all LTX and usually is combined with increased morbidity and mortality of 30-40%. A deficit of C1-INH presents a clinical picture of severe capillary leakage. Therefore, we hypothesized that application of C1-INH in LTX recipients that show first signs of severe ischemia-reperfusion injury attenuates PGD. Methods and Materials: All LTX recipients that showed low oxygenation indices (o100 mmHg/FiO2) at the end of surgery while still in the operating theatre, were immediately treated with 1000 IE of C1-INH starting as of 05/2010. Postoperative data of all LTX recipients since that date were collected and analyzed. Results: A total of 296 LTX were performed between May 2010 and September 2012 at our centre. Out of this, 24 patients (8.11%) developed a low oxygenation index at the end of surgery (mean 85.46 mmHg) and were treated with C1-INH. The PGD Score (ISHLT) was significantly higher in the C1-INH treated group directly postoperatively, 24 hours, 48 hours and 72 hours postoperatively (T0 2.42⫾0.21vs. 0,74⫾0.06, po0.0001; T24 1.79⫾0.17 vs. 0.73⫾0.05, po0.0001; T48 1.88⫾0.17 vs. 0.70⫾0.05, po0.0001; T72 1.66⫾0.17 vs. 0.66⫾0.05, po0.0001). Patients treated with C1-INH had a significantly longer ICU stay compared to other LTX patients (days 15.92⫾3,74 vs. 4.04⫾0.27 days, po0.0001), but ventilation time and hospital stay were not significantly longer. Out of the 24 patients being treated with C1-INH, 3 died due to a PGD-related cause. One-year-survival in the C1-INH group was lower compared to the patients without PGD and C1-INH (83.33% vs. 93.01%, p¼0.03), but was still in a favourable range. Conclusions: PGD is a serious complication after LTX, but treatment with C1-INH led to acceptable morbidity and mortality. Although survival in the C1-INH treated patients was lower than in the remaining collective, it was effectively as good or better as what is internationally regarded as reasonable outcome after LTX in general (483% one-year-survival). 607 Severity of End Organ Damage as a Predictor of Outcomes after Implantation of Continuous Flow Left Ventricular Assist Devices (LVAD) Z.C. Landis, B. Soleimani, E.R. Stephenson, A. El-Banayosy, W.E. Pae. Heart and Vascular Institute, Penn State Hershey Medical Center, Hershey, PA. Purpose: The optimal timing of implantation of LVAD in management of advanced heart failure remains controversial. We hypothesize that in patients with cardiogenic shock, the severity of end-organ
Conclusions: These results show that pre-operative SOFA score is a powerful predictor of outcomes after LVAD implantation. Long-term outcomes of patients with advanced heart failure treated with LVAD can be significantly improved by early intervention prior to emergence of end-organ dysfunction. 608 Overall Outcomes of Patients with Left Ventricular Assist Devices (LVADs) in Acute Rehabilitation Facility: How Safe Are These Patients at Rehabilitation Facilities? K.C. McCants, P.S. Combs, P. Raheja, S. Rhode, K. Vessels, A. Lenneman, E. Birks. Advanced Heart Failure, University of Louisville & Jewish Hospital, Louisville, KY. Purpose: Patients (pts) with LVADs are challenging with issues relating to transition of care and reducing hospital length of stay. However, in severely debilitated patients this can involve transitioning to long term care facilities, subacute and acute rehabilitation facilities. Currently, there are few centers that accept patients with LVADs which indirectly affect hospital length of stay (LOS). We report the outcomes including: