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Patients and Devices Reported to the MCSD Database (PowerPoint)

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Patients and Devices Reported to the MCSD Database (PowerPoint) Powered By Docstoc
					ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n=655
178 Deaths

                     (423)
 Percent Survival




                                   (224)




                                                                                     Deaths / Month
                                                   (137)
                                                                              (32)
                             Months     % Survival
                             1              83 %
                             3              74 %
                             6              67 %
                             12             50 %                          Hazard


                    Event: Death after Implant *


* censored at transplant
                                 Months after Device Implant
                                                2005
                    ISHLT
                              J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n=655
 Predicted % Mortality at 6 months


                                         Primary Device Implant:



                                                    LVAD + RVAD
                                                    at the same operation
                                                    (biventricular failure)
                                                                                     LVAD alone
                                                                                     (left ventricular failure)




                                             Age (years) at Device Implant
                                                           2005
                                     ISHLT
                                         J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004 (n=655)
 Cumulative Events per 100 Patients




                                                                          Infection Episodes
                                                                          (n=668)
                                                                   175

                                                                         Bleeding Episodes
                                                                   75    (n=396)
                                                                         Thromboembolism
                                                                    18   Episodes (n=86)



                                              Months after Device Implant

                                                            2005
                                      ISHLT
                                          J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n=655
66 Patients with Major Device Malfunction




                                                                                              Major Device Adverse Event / Month
                            (410)
Major Device Malfunction




                                         (212)
 Percent Freedom from




                                                             (122)

                                Months        % Survival                        (38)
                                1                 95 %
                                3                 92 %
                                6                 84 %                          Hazard
                                12                66 %


                                                               Event: Death after Implant *


                                       Months after Device Implant
     * censored at transplant

                                                      2005
                           ISHLT
                                    J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004
Bridge to Transplant

             Age > = 50 (n=292)                          Age < 30 (n=52)




                                  2005
        ISHLT
             J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004
Intent to Treat: Bridge to Recovery (n=35)
 Proportion of Patients


                          Alive
                          (Still waiting)




                                                            45 % Explanted (recovery)      45 %
                                                                                           37 %
                                                            27 %
                                                               Death (before transplant)

                                                 17 %       12 % Transplanted
                                                                                           12 %
                                                                                            5%


                                    Months after Device Implant

                                                     2005
                          ISHLT
                                   J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004
Intent to Treat: Destination Therapy (n=78)
                          Alive
 Proportion of Patients




                                                           65 %
                                                                              55 %

                                                           33 %
                                                            Death             34 %


                                                               Transplanted   11 %
                            Explanted (recovery) 0 % 2 %
                                                                              0%

                                   Months after Device Implant

                                                    2005
                          ISHLT
                                  J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004
Destination Therapy
               Age < 65 (n=37)                           Age >= 65 (n=41)




                                 2005
       ISHLT
             J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n=655

    Primary Device Implant                                       n

    LVAD (alone)                                                 542*
      Pulsatile flow, chronic device                                    487
      Continuous flow, chronic device                                   39

    LVAD + RVAD Combinations                                     100

    TAH Pulsatile flow, chronic device                           13

    Total                                                        655

* Type of VAD not specified in 16 patients


                                       2005
             ISHLT
                     J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n=655

Intention to Treat                              n          % of 655

Bridge to transplant                            513           78.3%
Bridge to recovery                               35            5.3%
Destination Therapy                              78           11.9%
Not specified                                    29            4.4%

Total                                           655           100%




                                 2005
        ISHLT
               J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n=655

Major Causes of Death                            n          % of 178
 Multiple organ failure                         62            34.8%
 Hemorrhage                                     27            15.2%
 Cardiovascular                                 22            12.4%
 Stroke                                         18            10.1%
 Infection                                      14             7.9%
 Pulmonary                                       9             5.1%
 Other                                          24            13.5%
 Unspecified                                     2             1.1%
 Total                                        178              100%

                                  2005
          ISHLT
                J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n=655
Risk factors for death* after device implant
Risk Factor                                     Relative Risk   P-value
EARLY PHASE OF HAZARD
  Concurrent placement of RVAD                      4.89        <.0001
  Age (older)                                       3.13        <.0001
  Female                                            2.53         .0003
  Platelet count (lower)                            2.13          .02
  WBC count (higher)                                2.01         .008
  Blood type A                                      1.89         .008
CONSTANT PHASE OF HAZARD
  Diabetes                                          2.01          .01
  Ventilator (pre-implant)                          1.84          .03
  Creatinine (higher)                               1.64          .05
*Patients are censored at time of transplant.
                                     2005
           ISHLT
                   J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n=655
Summary of Post-Implantation Patient-related Events
                 Event                        # of Patients     % of all Patients
Infection                                               134                32.5%
Bleeding                                                115                27.8%
Arrhythmia                                              100                24.2%
Renal dysfunction                                        85                20.6%
Respiratory dysfunction                                  66                16.0%
Neurological dysfunction                                 58                14.0%
Right ventricular dysfunction                            44                10.7%
Hepatic dysfunction                                      30                 7.2%
Cardiac tamponade                                        22                 5.3%
Thrombotic vascular complication                         18                 4.4%
Hematoma                                                 10                 2.4%
Pleural effusion                                          9                 2.2%
Internal organ compromise                                 5                 1.2%
Pacemaker implanted                                       2                 0.5%



                                      2005
           ISHLT
                    J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n=655
 Major Device Malfunctions                                     n

 Controller                                                    31
 Pump/pump drive unit                                          14
 Pump thrombosis                                               13
 Pump inflow                                                   11
 Percutaneous lead/drive line                                  4
 Pump outflow                                                  4
 Cannula dislodgement                                          1
 Power base electrical malfunction                             1
 Pump stoppage                                                 1
 Other                                                         3

 Total Events                                                  83

66 Patients with 83 major device malfunctions

                                     2005
           ISHLT
                   J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n=655
Intent to Treat: Bridge to Recovery
   Primary Device Implant                                        n

   LVAD (alone)                                                  21*
     Pulsatile flow, chronic device                                    16
     Continuous flow, chronic device                                    1

   LVAD + RVAD Combinations                                      14


   Total                                                         35

* Type of VAD not specified in 4 patients


                                       2005
             ISHLT
                     J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n=655

Indications for Destination Therapy                        n    % of 78

Advanced age                                               38   48.7%
Co-morbidity                                               28   35.9%
Fixed pulmonary hypertension                                8   10.3%
Contraindication to immunotherapy                           2    2.6%
Patient refuses transplant                                  2    2.6%

Total                                                      78   100%




                                 2005
        ISHLT
               J Heart Lung Transplant 2005;24:1182-1187
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n=655
Intent to Treat: Destination Therapy
 Primary Device Implant                                    n

 LVAD (alone)                                              74
   Pulsatile flow, chronic device                               71
   Continuous flow, chronic device                               3

 LVAD + RVAD Combinations                                  3

 TAH Pulsatile flow, chronic device                        1

 Total                                                     78



                                 2005
         ISHLT
               J Heart Lung Transplant 2005;24:1182-1187

				
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posted:9/15/2011
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