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Robert J. Steffen, MD, Eugene H. Blackstone, MD, Nicholas G

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1 Optimal Timing of Heart Transplant After HeartMate II Left Ventricular Assist Device Implantation 
Robert J. Steffen, MD, Eugene H. Blackstone, MD, Nicholas G. Smedira, MD, Edward G. Soltesz, MD, MPH, Katherine J. Hoercher, RN, Lucy Thuita, MS, Randall C. Starling, MD, MPH, Maria Mountis, DO, Nader Moazami, MD  The Annals of Thoracic Surgery  Volume 104, Issue 5, Pages (November 2017) DOI: /j.athoracsur Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 (A) Survival for the entire cohort starting at HeartMate II (Thoratec Corp, Pleasanton, CA) implantation, regardless of transplantation. (B) Survival for patients during HeartMate II support. (C) Survival after heart transplantation. Each symbol represents a death positioned on the vertical axis by Kaplan-Meier estimates. The vertical bars are confidence limits equivalent to 1 SE. The solid lines represent parametric survival estimates enclosed within a dashed 68% confidence band. The numbers below the horizontal axis represent patients remaining at risk. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 Predicted 3-year unadjusted survival after HeartMate II (Thoratec Corp, Pleasanton, CA) implant as duration of support increases. Survival is unchanged when transplantation occurs within 9 months. However, support longer than 9 months is associated with a progressive decrease in survival. The solid line is 3-year predicted survival enclosed within a dashed 68% confidence band. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Optimal timing of heart transplant after HeartMate II (Thoratec Corp., Pleasanton, CA) implant for a simulated low-risk P1, medium-risk P2, and high-risk P3 patient. The low-risk and medium-risk patients benefitted from waiting 3 months between HeartMate II implant and heart transplant. The high-risk patient had optimal survival when transplant occurred immediately after HeartMate II implant, with a continuous decrease in survival with increased time on the HeartMate II. The solid lines are 3-year predicted survival enclosed within a dashed 68% confidence band.CABGValve OperationHypertensionAlbumin (g/dL)GFR (mL · min–1 · 1.73 m2)MAP (mm Hg)P1NoNoNo49060P2YesNoYes49060P3NoYesYes CABG = coronary artery bypass grafting; GFR = glomerular filtration rate; MAP = mean arterial pressure; P = patient. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Predicted 3-year survival after HeartMate II (Thoratec Corp, Pleasanton, CA) implant for patients who experience dialysis, intracranial hemorrhage (ICH), or device exchange at 1 month. The solid lines are 3-year predicted survival enclosed within a dashed 68% confidence band. The inset depicts the hazard for each event on an expanded horizontal axis. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions


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