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Presentation transcript:

Bridge to transplant experience: Factors influencing survival to and after cardiac transplant Nicholas G. Smedira, MD, Katherine J. Hoercher, RN, Dustin Y. Yoon, MS, Jeevanantham Rajeswaran, MSc, Lynne Klingman, MT, CHS, Randall C. Starling, MD, MPH, Eugene H. Blackstone, MD The Journal of Thoracic and Cardiovascular Surgery Volume 139, Issue 5, Pages 1295-1305.e4 (May 2010) DOI: 10.1016/j.jtcvs.2009.12.006 Copyright © 2010 Terms and Conditions

Figure 1 Sequence of MCS. The volume of each sphere is proportional to the number of patients who received that support device. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1295-1305.e4DOI: (10.1016/j.jtcvs.2009.12.006) Copyright © 2010 Terms and Conditions

Figure 2 Survival while on each MCS device. This so-called modulated renewal format censors patients when another device is used or transplant occurs. Time zero is reset at each sequential change in mode of MCS. Each symbol represents a death, vertical bars represent 68% confidence limits (equivalent to ±1 standard error), and numbers in parentheses represent patients remaining at risk. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1295-1305.e4DOI: (10.1016/j.jtcvs.2009.12.006) Copyright © 2010 Terms and Conditions

Figure 3 Predicted 6-month survival on MCS. Depicted are baseline patient characteristics and differences in age. A, Survival according to age. B, Survival according to age and whether or not the patient was on LVAD support. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1295-1305.e4DOI: (10.1016/j.jtcvs.2009.12.006) Copyright © 2010 Terms and Conditions

Figure 4 Five-year survival after transplant according to duration of MCS for a low-risk patient. Dashed lines represent 68% confidence limits of upper and lower curves. A, Survival simulated according to whether or not global sensitization had occurred on MCS. B, Survival after transplant simulated by number of devices implanted and subsequent transplantation. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1295-1305.e4DOI: (10.1016/j.jtcvs.2009.12.006) Copyright © 2010 Terms and Conditions

Figure 5 Overall survival after initiating MCS, regardless of time of transplant. Format is as in Figure 2. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1295-1305.e4DOI: (10.1016/j.jtcvs.2009.12.006) Copyright © 2010 Terms and Conditions

Overall survival on MCS, with patients censored at transplant Overall survival on MCS, with patients censored at transplant. Each symbol represents a death, vertical bars represent 68% confidence limits (equivalent to ±1 standard error), and numbers in parentheses represent patients remaining at risk. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1295-1305.e4DOI: (10.1016/j.jtcvs.2009.12.006) Copyright © 2010 Terms and Conditions

Survival after transplant of patients surviving MCS Survival after transplant of patients surviving MCS. Format is as in Figure E1. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1295-1305.e4DOI: (10.1016/j.jtcvs.2009.12.006) Copyright © 2010 Terms and Conditions

Survival on MCS. Solid line is point estimate based on Table 2, and dashed lines are 68% confidence limits from modulated renewal analyses. A, Baseline patient has MCS initiated with a non-LVAD device for 2 weeks and then requires LVAD support. B, Baseline patient has MCS initiated with an LVAD, but at 2 months requires non-LVAD support. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1295-1305.e4DOI: (10.1016/j.jtcvs.2009.12.006) Copyright © 2010 Terms and Conditions

Predicted probability of surviving both MCS and transplant to 5 years after initiating MCS according to duration of MCS. Dashed lines are estimated 68% confidence limits. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1295-1305.e4DOI: (10.1016/j.jtcvs.2009.12.006) Copyright © 2010 Terms and Conditions

Competing risks of remaining alive on MCS, dying on MCS, and undergoing transplantation. All probabilities add to 100%. Thus, for example, “Alive on MCS” is equivalent to the distribution times on MCS. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1295-1305.e4DOI: (10.1016/j.jtcvs.2009.12.006) Copyright © 2010 Terms and Conditions