BIOLOGIC AND THERAPEUTIC ADVANCES IN HEART TRANSPLANTATION I

A.S. Nagji¹, D.J. Lapar², C.C. Ballew², J.D. Bergin³, J.A. Kern^2
1Surgery, University of Virginia, Charlottesville/VA/UNITED STATES OF AMERICA, ²Surgery, University of Virginia, Charlottesville/UNITED STATES OF AMERICA, ³Medicine, University of Virginia, Charlottesville/UNITED STATES OF AMERICA

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Introduction: With the shortage of donor cardiac allografts, many potential cardiac transplant recipients are now being bridged to transplant with continuous-flow left ventricular assist devices(LVADs). Though ventricular tachycardia (VT) and ventricular fibrillation (VF) are common in patients with cardiomyopathy and LVADs, recent evidence has pointed to a possible increased rate of VT/VFin patients receiving the HeartMate II. The objective of this study was to evaluate the rates of VT/VF that necessitated either chemical or electrical cardioversion in patients who received theHeartMate XVE compared to those who received the HeartMate II.
Methods: Discharge records were identified for patients who received either the HeartMate XVE or HeartMate II as a bridge to transplant at a single tertiary care facility from January 2006 throughDecember 2009. Univariate analysis (Fisher's Exact and Analysis of Variance Tests) was performed to assess the unadjusted association between peri-operative factors of patients who received eitherthe HeartMate XVE or HeartMate II.
Results: 37 consecutive LVAD patients being bridged to transplant were identified. Fourteen (37.8%) received the HeartMate XVE and 23 (62.2%) received the HeartMate II. On univariate analysis it wasfound that patients receiving the HeartMate II were more likely to have had a previous myocardial infarction (p=0.03). Otherwise, univariate analysis of peri-operative factors demonstrated nosignificant differences between the two patient populations. Discharge records indicated 11 patients (3 HeartMate XVE and 8 HeartMate II) with post-operative VT/VF. Of the 13 patients (5 HeartMateXVE and 8 HeartMate II) with known pre-operative VT/VF only 4 patients (2 HeartMate XVE and 2 HeartMate II) had persistent post-operative VT/VF. Importantly, of the 7 new cases of post-operativeVT/VF, 6 (85.7%) occurred in patients who received the HeartMate II (p=0.183).
Conclusions: Our experience has demonstrated that with regards to the development of new-onset ventricular arrhythmias following placement of LVADs, the rate of VT/VF is higher with the HeartMate IIthan with the HeartMate XVE. With the increasing use of continuous flow LVADs as a bridge to transplant or destination therapy, ventricular arrhythmias may become a limiting factor requiringadditional/novel therapy, or the need for earlier transplantation.

Disclosure: All authors have declared no conflicts of interest.