Temporary left ventricular assist devices as a bridge to heart transplantation

Abstract

Background To create equitable access to donor organs for the highest mortality patients, the cardiac transplant allocation system now prioritizes patients with surgically implanted temporary left ventricular assist devices (T‐LVADs). The outcomes following a direct bridge from a T‐LVAD to orthotopic heart transplant (OHT) are not well delineated. Aim This study investigates the T‐LVAD waitlist outcomes and compares the posttransplant outcomes in patients bridged to OHT with surgically implanted T‐LVADs to patients bridged with durable continuous‐flow left ventricular assist devices (CF‐LVADs). Methods Adults recorded in the United Network for Organ Sharing registry bridged to OHT with a durable CF‐LVAD and T‐LVADs, with or without temporary right ventricular assist devices (T‐RVADs), between 2010 and 2018 were included. Propensity matching and multivariable Cox regression were utilized to compare outcomes. Results Of 504 patients waitlisted with T‐LVADs, the majority were transplanted (50%), bridged to CF‐LVAD (17%), or recovered (9%). A total of 9047 recipients were bridged to OHT during the study period with 8875 CF‐LVADs and 172 T‐LVADs. Early survival in propensity‐matched T‐LVAD ± T‐RVAD patients was similar to CF‐LVAD ± T‐RVAD patients but reduced at a 1‐year follow‐up. This difference in survival at 1‐year follow‐up was attributable to significantly reduced survival in patients with combined T‐LVAD + T‐RVAD support when compared with CF‐LVAD, isolated T‐LVAD and combined CF‐LVAD + T‐RVAD support (80% vs 90% vs 90% vs 91%; P = .005). Conclusions This study demonstrates that most patients waitlisted with a T‐LVAD are successfully bridged to durable therapy or recover, and those bridged to OHT have acceptable posttransplant outcomes, particularly when T‐RVADs are not required.

The impact of changes in renal function during waitlist time on outcomes after heart transplantation

“…While durable VADs were associated with worsened CKD stage, percutaneous axial flow devices, IABP, ECMO, and temporary VADs were all associated with improved CKD stage between waitlisting and OHT. In the context of recent studies demonstrating largely acceptable post-transplant survival outcomes of temporary MCS, [29][30][31] these findings suggest that temporary MCS may be a preferable option to durable VAD in patients with existing renal insufficiency at listing and those at high risk of developing renal insufficiency while on the waitlist.…”

Recent advances in implantable hydrogels for treating heart failure

“…To temporarily restore heart functions, mechanical assist devices are used to support circulation for HF treatment, 37 such as left ventricular assist device (LVAD). Pagani et al 38 designed a continuous‐flow LVAD to provides hemodynamic support for the patients who have been waiting for heart transplantation for at least 18 months.…”