Impact of frailty on mortality and morbidity in bridge to transplant recipients of contemporary durable mechanical circulatory support.

Muthiah, K; Wilhelm, K; Robson, D; Raju, H; Aili, SR; Jha, SR; Pierce, R; Fritis-Lamora, R; Montgomery, E; Gorrie, N; Deveza, R; Brennan, X; Schnegg, B; Jabbour, A; Kotlyar, E; Keogh, AM; Bart, N; Conellan, M; Iyer, A; Watson, A; Granger, E; Jansz, PC; Hayward, C; Macdonald, PS

Impact of frailty on mortality and morbidity in bridge to transplant recipients of contemporary durable mechanical circulatory support.

Muthiah, K Wilhelm, K Robson, D Raju, H Aili, SR Jha, SR Pierce, R Fritis-Lamora, R Montgomery, E

Gorrie, N Deveza, R Brennan, X Schnegg, B Jabbour, A Kotlyar, E Keogh, AM Bart, N Conellan, M Iyer, A Watson, A Granger, E Jansz, PC Hayward, C Macdonald, PS

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Journal of Heart and Lung Transplantation, 2022, 41, (6), pp. 829-839
Issue Date:: 2022-06

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Field	Value	Language
dc.contributor.author	Muthiah, K
dc.contributor.author	Wilhelm, K
dc.contributor.author	Robson, D
dc.contributor.author	Raju, H
dc.contributor.author	Aili, SR
dc.contributor.author	Jha, SR
dc.contributor.author	Pierce, R
dc.contributor.author	Fritis-Lamora, R
dc.contributor.author	Montgomery, E https://orcid.org/0000-0003-3470-6901
dc.contributor.author	Gorrie, N
dc.contributor.author	Deveza, R
dc.contributor.author	Brennan, X
dc.contributor.author	Schnegg, B
dc.contributor.author	Jabbour, A
dc.contributor.author	Kotlyar, E
dc.contributor.author	Keogh, AM
dc.contributor.author	Bart, N
dc.contributor.author	Conellan, M
dc.contributor.author	Iyer, A
dc.contributor.author	Watson, A
dc.contributor.author	Granger, E
dc.contributor.author	Jansz, PC
dc.contributor.author	Hayward, C
dc.contributor.author	Macdonald, PS
dc.date.accessioned	2022-11-16T00:41:49Z
dc.date.available	2022-02-14
dc.date.available	2022-11-16T00:41:49Z
dc.date.issued	2022-06
dc.identifier.citation	Journal of Heart and Lung Transplantation, 2022, 41, (6), pp. 829-839
dc.identifier.issn	0887-2570
dc.identifier.issn	1557-3117
dc.identifier.uri	http://hdl.handle.net/10453/163500
dc.description.abstract	BACKGROUND: Frailty is associated with adverse outcomes in advanced heart failure. We studied the impact of frailty on postoperative outcomes in bridge to transplant (BTT) durable mechanical circulatory support (MCS) recipients. METHODS: Patients undergoing left ventricular assist device (LVAD, n = 96) or biventricular support (BiV, n = 11) as BTT underwent frailty assessment. Frailty was defined as ≥ 3 physical domains of the Fried's Frailty Phenotype (FFP) or ≥ 2 physical domains of the FFP plus cognitive impairment on the Montreal Cognitive Assessment (MoCA). RESULTS: No difference in mortality at 360 days was observed in frail (n = 6/38, 15.8%) vs non-frail (n = 4/58, 6.9%) LVAD supported patients, p = 0.19. However, there was a significant excess mortality in frail BiV (n = 4/5) vs non-frail BiV (n = 0/6) supported patients, p = 0.013. In all patients, frail patients compared to non-frail patients experienced longer intensive care unit stay, 12 vs 6 days (p < 0.0001) and hospital length of stay, 48 vs 27 days (p < 0.0001). There was no difference in hemocompatibility and infection related adverse events. The majority (n = 22/29, 75.9%) of frail patients became non-frail following MCS; contrastingly, a minority (n = 3/42, 7.1%) became frail from being non-frail (p = 0.0003). CONCLUSIONS: Abnormal markers of frailty are common in patients undergoing BTT-MCS support and those used herein predict mortality in BiV-supported patients, but not in LVAD patients. These findings may help us better identify patients who will benefit most from BiV-BTT therapy.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation	http://purl.org/au-research/grants/nhmrc/1074386
dc.relation.ispartof	Journal of Heart and Lung Transplantation
dc.relation.isbasedon	10.1016/j.healun.2022.02.008
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1102 Cardiorespiratory Medicine and Haematology
dc.subject.classification	Surgery
dc.subject.mesh	Frailty
dc.subject.mesh	Heart Failure
dc.subject.mesh	Heart Transplantation
dc.subject.mesh	Heart-Assist Devices
dc.subject.mesh	Humans
dc.subject.mesh	Morbidity
dc.subject.mesh	Transplant Recipients
dc.subject.mesh	Frailty
dc.subject.mesh	Heart Failure
dc.subject.mesh	Heart Transplantation
dc.subject.mesh	Heart-Assist Devices
dc.subject.mesh	Humans
dc.subject.mesh	Morbidity
dc.subject.mesh	Transplant Recipients
dc.subject.mesh	Humans
dc.subject.mesh	Heart-Assist Devices
dc.subject.mesh	Heart Transplantation
dc.subject.mesh	Morbidity
dc.subject.mesh	Heart Failure
dc.subject.mesh	Transplant Recipients
dc.subject.mesh	Frailty
dc.title	Impact of frailty on mortality and morbidity in bridge to transplant recipients of contemporary durable mechanical circulatory support.
dc.type	Journal Article
utslib.citation.volume	41
utslib.location.activity	United States
utslib.for	1102 Cardiorespiratory Medicine and Haematology
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Science
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2022-11-16T00:41:46Z
pubs.issue	6
pubs.publication-status	Published
pubs.volume	41
utslib.citation.issue	6

Abstract:

BACKGROUND: Frailty is associated with adverse outcomes in advanced heart failure. We studied the impact of frailty on postoperative outcomes in bridge to transplant (BTT) durable mechanical circulatory support (MCS) recipients. METHODS: Patients undergoing left ventricular assist device (LVAD, n = 96) or biventricular support (BiV, n = 11) as BTT underwent frailty assessment. Frailty was defined as ≥ 3 physical domains of the Fried's Frailty Phenotype (FFP) or ≥ 2 physical domains of the FFP plus cognitive impairment on the Montreal Cognitive Assessment (MoCA). RESULTS: No difference in mortality at 360 days was observed in frail (n = 6/38, 15.8%) vs non-frail (n = 4/58, 6.9%) LVAD supported patients, p = 0.19. However, there was a significant excess mortality in frail BiV (n = 4/5) vs non-frail BiV (n = 0/6) supported patients, p = 0.013. In all patients, frail patients compared to non-frail patients experienced longer intensive care unit stay, 12 vs 6 days (p < 0.0001) and hospital length of stay, 48 vs 27 days (p < 0.0001). There was no difference in hemocompatibility and infection related adverse events. The majority (n = 22/29, 75.9%) of frail patients became non-frail following MCS; contrastingly, a minority (n = 3/42, 7.1%) became frail from being non-frail (p = 0.0003). CONCLUSIONS: Abnormal markers of frailty are common in patients undergoing BTT-MCS support and those used herein predict mortality in BiV-supported patients, but not in LVAD patients. These findings may help us better identify patients who will benefit most from BiV-BTT therapy.

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http://hdl.handle.net/10453/163500