Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Novel Scoring System to Predict Ineligibility for Bridge to Implantable Left Ventricular Assist Device as Destination Therapy Before Extracorporeal Ventricular Assist Device Implantation – For the Coming Era of Destination Therapy in Japan –
Daisuke NittaKoichiro KinugawaTeruhiko ImamuraMiyoko EndoToshiro InabaHisataka MakiEisuke AmiyaMasaru HatanoOsamu KinoshitaKan NawataShunei KyoMinoru Ono
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Article ID: CJ-15-1030


Background:Although destination therapy (DT) is now expected to be a promising strategy for those who are not suitable for heart transplantation in Japan, there has not been any investigation into ineligibility for bridging to implantable left ventricular assist device (I-LVAD) as DT among patients with extracorporeal LVAD.Methods and Results:We retrospectively studied 85 patients who had received an extracorporeal LVAD. To assess ineligibility for a bridge to I-LVAD for DT, we defined DT ineligibility (DTI) as BiVAD requirement, death within 6 months, and persistent end-organ dysfunction (medium or high J-VAD risk score) at 6 months after extracorporeal LVAD implantation. DTI was recorded for 32 patients. Uni/multivariate analysis showed that smaller left ventricular diastolic dimension (<64 mm; [odds ratio (OR) 4.522]), continuous hemodiafiltration (OR 4.862), past history of cardiac surgery (OR 6.522), and low serum albumin level (<3.1 g/dl; OR 10.064) were significant predictors of DTI. By scoring 2, 2, 3, 4 points, respectively, considering each OR, we constructed a novel scoring system for DTI (DTI score), which stratified patients into 3 risk strata: low (0–3 points), medium (4–6 points), and high (7–11 points), from the view point of DTI risk (low 8%, medium 46%, high 93%, respectively).Conclusions:DTI score is a promising tool for predicting ineligibility for I-LVAD as DT before extracorporeal VAD implantation.

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