Impact of the type of ventricular assist device on the long-term development of coronary transplant vasculopathy

A212 Aims: Left ventricular assist device (LVAD) as bridge to heart transplantation is associated with the development of anti-HLA alloantibodies, a risk factor for acute vascular rejection. The aim of this study is to determine the influence of LVAD choice and duration of support on the long-term development of post transplant coronary vasculopathy. Methods: Between 1992 and 2003, 190 patients were bridged to transplantation with LVADs. At long-term follow-up, patients bridged with HeartMate (n = 88) were compared to those bridged with Novacor (n = 27). Coronary angiograms were prospectively evaluated for the presence and degree of coronary vasculopathy. Results: All patients were highly sensitized. Twenty-one percent had T-cell panel reactive antibodies greater than 10% at the time of transplant and 25% had positive T-cell crossmatches. Length of support was similar between both groups (HeartMate, 95 days vs. Novacor, 85 days, P=.5) Within the first 3 years of follow-up, development of coronary vasculopathy was similar between the two groups. However, at 4 years post transplantation, a difference was detected. Patients bridged with HeartMate had more normal coronary angiograms than those with Novacor (68% vs. 55%). Furthermore, in those patients bridged with HeartMate, the severity of vasculopathy was worse than in those patients bridged with Novacor (P=.05).(Table) The length of LVAD bridge did not influence the occurrence of coronary vasculopathy at any time of follow-up (P>.05). Conclusions: The type of LVAD used to bridge patients to transplantation may influence the long-term development of post-transplant coronary vasculopathy, regardless of the length of support.Figure