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| |  Pre-VAD Implant Patient Characteristics Highly Associated with Survival to Transplant and Longer Term Survival: Presented at STS By Christine Frank SAN DIEGO, CA -- January 30, 2007 -- Researchers devised a preoperative risk score that can predict successful bridge to left ventricular assist device (LVAD) implantation among patients with chronic congestive heart failure (CCHF), researchers said here at the 43rd Annual Society of Thoracic Surgeons Conference (STS). Their risk assessment tool identified pre-implantation patient characteristics that were highly associated with survival to transplant and long-term survival. "Ventricular assistance devices are crucial to the effective management of heart transplant candidates," said Mark J. Russo, MD, postdoctoral research fellow, Columbia-Presbyterian Medical Center, New York, New York, and researcher with the International Center for Health Outcomes and Innovation Research (INCHOIR). "Improved patient selection determines the success, however." The retrospective review analysis included 132 CCHF patients (diagnosis greater than or equal to 6 months) who underwent implantation of LVADs as a bridge to transplant (BTT). Outcome measures were survival to transplantation and 1-year survival. Univariate and multivariable analyses were performed to determine the predictors of survival to transplant after LVAD insertion. Using the relative risks for each variable identified, the research team devised a risk factor summation score. To assess the predictive power of the model, they constructed ROC curves to determine the area under the curve (AUC). Patient risk was deter-mined by assigning points based on the following scoring scheme: albumin <2.9 (1 point), hematocrit <27 (1 point), central venous pressure >16 (1 point), age 56 years old (1 point), CrCl <55.2 (2 point), female sex (2 point), previous cardiac surgery (2 point), PT >16 (2 point), and BMI less than or equal to 20.4 (3 point). Survival to transplant by risk score is as follows: 0-4, 96.2% (n = 79); 5-8, 59.1% (n = 44); greater than or equal to 9, 11.1% (n = 9); the AUC was 0.87 (0.81-0.94). This risk score is highly predictive of longer term survival with 1-year survival following LVAD implant by risk score as follows: 0-4 86.0% (n = 57); 5-8 46.0% (n = 37); greater than or equal to 9 11.1% (n = 9); the AUC was 0.80 (0.71-0.88) "This model was based on historical data," said Dr. Russo. "The study was also limited in that it was retrospective, small in size and data was from only a single center." Regardless, said Dr. Russo, "The study also offers insights for the eventual use of destination therapy in less morbid populations." "Because CCHF patients may undergo non-emergent VAD implant, this risk score could assist in patient selection, timing of implant, and pre-implant optimization of patients," Dr. Russo concluded.
[Presentation title: Preoperative Screening Scale Predicts Successful Bridge to Transplantation Among Chronic Congestive Heart Failure Patients. Abstract 17]
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