Presentation is loading. Please wait.

Presentation is loading. Please wait.

Predicting Major Outcomes after MCSD Implant 1 Risk Factors for Death, Transplant, and Recovery James Kirklin, MD David Naftel, PhD.

Published byMartin Horn Modified over 8 years ago

Similar presentations

Presentation on theme: "Predicting Major Outcomes after MCSD Implant 1 Risk Factors for Death, Transplant, and Recovery James Kirklin, MD David Naftel, PhD."— Presentation transcript:

1 Predicting Major Outcomes after MCSD Implant 1 Risk Factors for Death, Transplant, and Recovery James Kirklin, MD David Naftel, PhD

2 Predicting Major Outcomes after MCSD Implant 2 Two approaches: Simultaneous parametric modeling of the probabilities of the time related events based on a patient’s risk factors Simultaneous non-parametric estimation of the probabilities of the time related events based on sub-groups of patients

3 Months post implant Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 n at risk: 9359 6195 4024 2736 1820 1194 711 408 174 3 Outcome Death Transplant Recovery Death Transplant Recovery Outcome/Month Instantaneous Rate (Hazard) of Outcomes

4 Months post implant % Freedom from Transplantation % Free from Device Strategy n txplTXPL at 1 yr BTT Listed 2473 1188 56% BTT Likely 2140 801 67% BTT Mod Likely 958 178 83% BTT Unlikely 299 35 90% Destination Therapy 3370 190 95% Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 4 Event: Transplantation (censored at death or recovery) BTT Unlikely BTT Listed BTT Mod Likely BTT Likely Destination Therapy Device Strategy at Time of Implant

5 Months post implant Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 n at risk: 9359 6195 4024 2736 1820 1194 711 408 174 5 Outcome Death Transplant Recovery Death Transplant Recovery Outcome/Month Instantaneous Rate (Hazard) of Outcomes

6 INTERMACS

7 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 Device Strategy 1 2 3 4 5 6 7 BTT: Listed BTT: Likely BTT: Moderately BTT: Unlikely DT Continuous Flow LVAD I N T E R M A C S L E V E L S

8 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 Device Strategy 1 2 3 4 5 6 7 BTT: Listed BTT: Likely BTT: Moderately BTT: Unlikely DT Continuous Flow LVAD I N T E R M A C S L E V E L S

9 Months after Implant Proportion of Patients Alive (device in place) 47% Transplanted 38% Dead 13% Recovery 1% Outcome % at 1 year 9 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 CFLVAD BTT Listed LEVEL 1, n= 317

10 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 Device Strategy 1 2 3 4 5 6 7 BTT: Listed BTT: Likely BTT: Moderately BTT: Unlikely DT Continuous Flow LVAD I N T E R M A C S L E V E L S

11 Months after Implant Proportion of Patients Alive (device in place) 63% Transplanted 4% Dead 31% Recovery 2% Outcome % at 1 year 11 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 CFLVAD Destination Therapy LEVEL 1, n=344

12 Months after Implant Proportion of Patients Alive (device in place) 70% Transplanted 3% Dead 26% Recovery 1% Outcome % at 1 year 12 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 CFLVAD Destination Therapy LEVEL 2, n=1128

13 Months after Implant Proportion of Patients Alive (device in place) 73% Transplanted 4% Dead 22% Recovery 1% Outcome % at 1 year 13 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 CFLVAD Destination Therapy LEVEL 3, n=1081

14 Months after Implant Proportion of Patients Alive (device in place) 76% Transplanted 3% Dead 21% Recovery 1% Outcome % at 1 year 14 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 CFLVAD Destination Therapy LEVELS 4-7, n=749

15 Months after Implant Proportion of Patients Alive (device in place) 46% Transplanted 40% Dead 13% Recovery 1% Outcome % at 1 year 15 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 CFLVAD BTT Listed LEVEL 2, n=1084

16 Months after Implant Proportion of Patients Alive (device in place) 51% Transplanted 39% Dead 9% Recovery 1% Outcome % at 1 year 16 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 CFLVAD BTT Listed LEVEL 3, n= 604

17 Months after Implant Proportion of Patients Alive (device in place) 45% Transplanted 42% Dead 12% Recovery 1% Outcome % at 1 year 17 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 CFLVAD BTT Listed LEVELS 4-7, n=394

18 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 Competing Outcomes Analysis for Continuous Flow LVADs % at 1 year Alive nDeath TransplantRecovery (a device in place) Destination Therapy, n=3302 Level 1 34431%4%2%63% Level 2112826%3%1%70% Level 3108122%4%1%73% Levels 4-7 74921%3%1%76% BTT: Listed, n=2399 Level 1 31713%38%1%47% Level 2108413%40%1%46% Level 3 604 9%39%1%51% Levels 4-7 39412%42%1%45%

19 Months after Implant Proportion of Patients Alive (device in place) 9% Transplanted 59% Dead 32% (Recovery 0%) Outcome % at 1 year 19 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 TAH BTT Listed LEVEL 1, n=47

20 Months after Implant Proportion of Patients Alive (device in place) 11% Transplanted 70% Dead 19% (Recovery 0%) Outcome % at 1 year 20 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 TAH BTT Listed LEVEL 2, n=75

21 Months post implant % Survival Deaths/months Hazard (early + late) n=9359, Deaths=2280 Months% Survival 195% 1280% 2469% 36 59% 4847% Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 n at risk: 9359 6195 4024 2736 1820 1194 711 408 174 21 Event: Death (censored at transplantation or recovery)

22 % Freedom Months from TXPL 199% 1276% 2462% 36 56% 4852% Months post implant % Freedom from Transplantation Transplants/months Hazard (early + constant) n=9359, Transplants= 2422 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 n at risk: 9359 6195 4024 2736 1820 1194 711 408 174 22 Event: Transplantation (censored at death or recovery)

23 % Freedom Months from Recovery 1 100% 12 99% 24 98% 36 97% 48 96% Months post implant % Freedom from Recovery Recovery/months Hazard (constant) n=9360, Recovery= 89 Continuous Flow LVAD/BiVAD Implants: 2008 – 2013, n=9359 n at risk: 9359 6195 4024 2736 1820 1194 711 408 174 23 Event: Recovery (censored at death or transplantation)

Download ppt "Predicting Major Outcomes after MCSD Implant 1 Risk Factors for Death, Transplant, and Recovery James Kirklin, MD David Naftel, PhD."

Similar presentations

ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n=655 178 Deaths * censored at transplant Percent Survival Months after Device Implant Deaths / Month Event:

ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n= Deaths * censored at transplant Percent Survival Months after Device Implant Deaths / Month Event:
ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n=655 178 Deaths * censored at transplant Percent Survival Months after Device Implant Deaths / Month Event:

ISHLT/MCSD Analysis: Jan 2002 – Dec 2004, n= Deaths * censored at transplant Percent Survival Months after Device Implant Deaths / Month Event:
Can Comparative Effectiveness Study Tell Us What Is The Best Therapy For Class IV Heart Failure? Beta blockers or LVADs?

Can Comparative Effectiveness Study Tell Us What Is The Best Therapy For Class IV Heart Failure? Beta blockers or LVADs?
Hemolysis in Patients Supported with Durable, Long-Term Left Ventricular Assist Device Therapy Jason N. Katz, MD,MHS; Brian C. Jensen, MD; Patricia P.

Hemolysis in Patients Supported with Durable, Long-Term Left Ventricular Assist Device Therapy Jason N. Katz, MD,MHS; Brian C. Jensen, MD; Patricia P.
Equipoise Does Not Exist for REVIVE IT Andrew Boyle, MD Heart and Vascular Center Director, Florida Chairman of Cardiology Medical Director of Heart Failure,

Equipoise Does Not Exist for REVIVE IT Andrew Boyle, MD Heart and Vascular Center Director, Florida Chairman of Cardiology Medical Director of Heart Failure,
What have we learned? What is next? Panel B: Functional Capacity, Quality of Life and Outcomes H.Functional Capacity I.Neurocognitive Assessment J.Quality.

What have we learned? What is next? Panel B: Functional Capacity, Quality of Life and Outcomes H.Functional Capacity I.Neurocognitive Assessment J.Quality.
Biventricular Failure – Total Artificial Heart Francisco A. Arabía, MD Director, CHSI Center for Surgical Device Management Cedars-Sinai Heart Institute.

Biventricular Failure – Total Artificial Heart Francisco A. Arabía, MD Director, CHSI Center for Surgical Device Management Cedars-Sinai Heart Institute.
Predicting Patients at Risk for Poor Global Outcomes after DT- MCS Therapy Suzanne V. Arnold, MD, MHA Saint Luke’s Mid America Heart Institute/UMKC May.

Predicting Patients at Risk for Poor Global Outcomes after DT- MCS Therapy Suzanne V. Arnold, MD, MHA Saint Luke’s Mid America Heart Institute/UMKC May.
Periportal Fibrosis Without Cirrhosis Does Not Affect Outcomes Following Continuous Flow Ventricular Assist Device Implantation Jonathon E. Sargent, BS,

Periportal Fibrosis Without Cirrhosis Does Not Affect Outcomes Following Continuous Flow Ventricular Assist Device Implantation Jonathon E. Sargent, BS,
Presentations: Quantifying the impact of adverse events on HRQOL early after implant Patient selection and estimation of prognosis using health status.

Presentations: Quantifying the impact of adverse events on HRQOL early after implant Patient selection and estimation of prognosis using health status.
Predicting Major Outcomes after MCSD Implant 1 Risk Factors for Death, Transplant, and Recovery James Kirklin, MD David Naftel, PhD.

Predicting Major Outcomes after MCSD Implant 1 Risk Factors for Death, Transplant, and Recovery James Kirklin, MD David Naftel, PhD.
Interagency Registry for Mechanically Assisted Circulatory Support Marissa A. Miller, DVM, MPH National Heart, Lung, & Blood Institute.

Interagency Registry for Mechanically Assisted Circulatory Support Marissa A. Miller, DVM, MPH National Heart, Lung, & Blood Institute.
Josef Stehlik, MD, MPH Associate Professor of Medicine Medical Director, Heart Transplant Program University of Utah School of Medicine Director, ISHLT.

Josef Stehlik, MD, MPH Associate Professor of Medicine Medical Director, Heart Transplant Program University of Utah School of Medicine Director, ISHLT.
MCS in Special Populations: The Use of Mechanical Support in Adults with Congenital Heart Disease 9 th Annual Meeting May 15, 2015 Christina VanderPluym,MD.

MCS in Special Populations: The Use of Mechanical Support in Adults with Congenital Heart Disease 9 th Annual Meeting May 15, 2015 Christina VanderPluym,MD.
Survival following VAD complications: implications for transplant priority. Todd Dardas, MD, MS May 16, 2015.

Survival following VAD complications: implications for transplant priority. Todd Dardas, MD, MS May 16, 2015.
Development of a novel predictive model for mortality post continuous flow LVAD implant using Bayesian Networks (BN) N. A. Loghmanpour 1, M. K. Kanwar.

Development of a novel predictive model for mortality post continuous flow LVAD implant using Bayesian Networks (BN) N. A. Loghmanpour 1, M. K. Kanwar.
INTERMACS: June 2006 – December 2012: CMS Report Adults: n=7849 All primary implants as of 12/31/2012 n= 7928 Pediatric patients: n=79 (patients < 19 yrs.

INTERMACS: June 2006 – December 2012: CMS Report Adults: n=7849 All primary implants as of 12/31/2012 n= 7928 Pediatric patients: n=79 (patients < 19 yrs.
Risk Factors for Adverse Outcome after HeartMate II Jennifer Cowger, MD, MS St. Vincent Heart Center of Indiana Advanced Heart Failure, Transplant, & Mechanical.

Risk Factors for Adverse Outcome after HeartMate II Jennifer Cowger, MD, MS St. Vincent Heart Center of Indiana Advanced Heart Failure, Transplant, & Mechanical.
“Rise of the Machines” Todd D. Edwards MD FACC FACP FASNC.

“Rise of the Machines” Todd D. Edwards MD FACC FACP FASNC.
Mechanical Circulatory Support in Special Populations Renzo Y. Loyaga-Rendon MD.,PhD.. Assistant Professor Advanced Heart Failure Section University of.

Mechanical Circulatory Support in Special Populations Renzo Y. Loyaga-Rendon MD.,PhD.. Assistant Professor Advanced Heart Failure Section University of.

Similar presentations

Ads by Google