Contact

  • Academic
    kcallon@stanford.edu
    University - Student Department: Computer Science Position: Undergraduate
    University - Student Department: Computer Science Position: Graduate

All Publications

  • Long-term survival in patients with post-LVAD right ventricular failure: multi-state modelling with competing outcomes of heart transplant. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Shad, R., Fong, R., Quach, N., Bowles, C., Kasinpila, P., Li, M., Callon, K., Castro, M., Guha, A., Suarez, E. E., Lee, S., Jovinge, S., Boeve, T., Shudo, Y., Langlotz, C. P., Teuteberg, J., Hiesinger, W. 2021

    Abstract

    BACKGROUND: Multicenter data on long term survival following LVAD implantation that make use of contemporary definitions of RV failure are limited. Furthermore, traditional survival analyses censor patients who receive a bridge to heart transplant. Here we compare the outcomes of LVAD patients who develop post-operative RV failure accounting for the transitional probability of receiving an interim heart transplantation.METHODS: We use a retrospective cohort of LVAD patients sourced from multiple high-volume centers based in the United States. Five- and ten-year survival accounting for transition probabilities of receiving a heart transplant were calculated using a multi-state Aalen Johansen survival model.RESULTS: Of the 897 patients included in the study, 238 (26.5%) developed post-operative RV failure at index hospitalization. At 10 years the probability of death with post-op RV failure was 79.28% vs 61.70% in patients without (HR 2.10; 95% CI 1.72 - 2.57; p=< .001). Though not significant, patients with RV failure were less likely to be bridged to a heart transplant (HR 0.87, p=.4). Once transplanted the risk of death between both patient groups remained equivalent; the probability of death after a heart transplant was 3.97% in those with post-operative RV failure shortly after index LVAD implant, as compared to 14.71% in those without.CONCLUSIONS AND RELEVANCE: Long-term durable mechanical circulatory support is associated with significantly higher mortality in patients who develop post-operative RV failure. Improving outcomes may necessitate expeditious bridge to heart transplant wherever appropriate, along with critical reassessment of organ allocation policies.

    View details for DOI 10.1016/j.healun.2021.05.002

    View details for PubMedID 34167863