Abstract 16922: Comparison of Different Strategies of LVAD Implantation for Bridging Patients to Heart Transplantation: An Analysis of the United Network for Organ Sharing
Purpose: Heart transplantation (HTx) provides improvement of survival in end-stage heart failure; however, this therapeutic option is limited due to donor shortage.Therefore, a left ventricular assist device (LVAD) implantation is increasingly used as a bridge-to-transplantation (BTT). The purpose of this study was to investigate the impact of early versus delayed timing of placement of LVAD support on likelihood of successful HTx and post-transplant outcome.
Methods: The United Network of Organ Sharing (UNOS) database was used to identify adults patients (≥18 yrs) listed for Thx from 2006 to 2012. Patients were classified into 3 groups: patients listed UNOS status 1A and 1B medically treated from the time of listing until HTx (Group M), patients medically treated at listing but requiring LVAD implantation while listed (Group M-to-V), and patients on LVAD support at the time of listing for HTx (Group V). The likelihood of receiving HTx and the post-HTx outcomes were compared among the groups.
Results: A total of 14,189 patients were included in this study. Patients on medical therapy had the highest waitlist mortality. Group M-to-V had similar waitlist mortality compared to Group V. (Table) Success rate of receiving HTx was highest in Group M compared to both VAD groups. Among the 1A status candidates, Group M-to-V showed the highest likelihood of HTx (OR: 3.59, 95% CI: 1.073-11.993; p=0.038).
Post-HTx 1-year survival was worse in Group V compared to Group M (89.4% vs. 91.1%, p=0.036).
Conclusion: LVAD support at the time or during listing as a BTT was associated with lower waitlist mortality. LVAD implantation in response to clinical deterioration during HTx listing is safe and not associated with increased mortality compared to patients with prior LVAD placement. Further, this strategy contributes to increased likelihood of successful HTx. Our observation supports a selective LVAD implantation strategy in patients listed for HTx.
- © 2013 by American Heart Association, Inc.