Left ventricular assist device bridging to heart transplantation: Comparison of temporary versus durable support

The 10 Commandments of Microaxial Temporary Left Ventricular Assist Devices

“…Due to the often hybrid nature of insertion and the complex patient populations involved, the use of a multidisciplinary heart team, and in particular a dedicated shock team, is critical to provide optimal outcomes. Given that these devices appear to have similar safety and efficacy to durable LVADs in bridging to cardiac transplantation, 31 but much greater versatility in enabling protected high-risk procedures and facilitating myocardial recovery, microaxial temporary LVADs have become a mainstay in the heart failure surgeon’s armamentarium. While much remains to be learned, the principles we have outlined provide a synthesis of the current understanding of best practices for microaxial temporary LVADs.…”

Heart Transplantation

“…Nevertheless, they show a higher mortality after transplantation and an increased probability of retransplantation [57]. Regarding the comparison of long-term circulatory support and temporary circulatory support devices, it is observed that LVAD had the same postoperative results compared to IABP [58], BiVAD patients had the same outcomes as LVAD patients classified in the second category in the new system [56], whereas the use of the total artificial heart device as bridging from VA-ECMO for patients awaiting transplantation is a viable option for a group of highly selected patients [59]. Patients with LVAD devices used for temporary circulatory support show a survival advantage compared to those with VA-ECMO used for bridging to transplantation [60], while it appears that the combined use of VA-ECMO with IABP in transplant patients did not offer additional benefits in either morbidity or mortality [61].…”

“…Initial data from registries show that in the new system, there is a reduction in the use of LVAD devices and, on the contrary, an increase in short-term circulatory support devices such as VA-ECMO and IABP as a bridging strategy, therefore significantly increasing the length of time patients are hospitalized [32]. In contrast, patients using an LVAD as a temporary bridge to transplant did not show a difference in one-year survival compared to patients who had an LVAD placed for long-term support [56]. Notably, with the new system, patients with LVADs have a lower chance of dying or being excluded from the list due to deterioration.…”