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Updated: Aug 24, 2026
Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
Optimal timing of cardiac transplantation after ventricular assist device implantation
James S Gammie1, Leah B Edwards, Bartley P Griffith
1Division of Cardiac Surgery, The University of Maryland Medical Center, Baltimore, 21201, USA. jgammie@smail.umaryland.edu
Insights
Timing of ventricular assist device (VAD) implantation before heart transplant impacts survival. Optimal outcomes occur 1-3 months post-VAD, while transplants within 2-4 weeks show lower survival rates.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Mechanical Circulatory Support
Background:
- Ventricular assist devices (VADs) are used to bridge patients to cardiac transplantation.
- The optimal timing for heart transplantation after VAD implantation is not well-defined.
- End-organ function and post-transplant survival are critical outcomes influenced by pre-transplant management.
Purpose of the Study:
- To determine the influence of the interval between VAD implantation and cardiac transplantation on end-organ function.
- To assess the impact of this interval on post-transplantation survival rates.
Main Methods:
- Retrospective review of United Network for Organ Sharing (UNOS) data.
- Analysis included 2692 adult heart transplantations performed in the US (October 1999 - March 2001).
- Patients bridged to transplantation with a VAD were specifically analyzed.
Main Results:
- 17% of heart transplant recipients were bridged with a VAD.
- Patients transplanted 2-4 weeks after VAD support showed improved creatinine and bilirubin levels.
- One-year survival was lower in the VAD group (79.7%) versus non-VAD (85.7%).
- Survival was significantly lower for transplants within 2 weeks of VAD implantation (74.2%) compared to later transplants (84.2%).
- Patients with VAD support >30 days without complications had 91.4% one-year survival.
- Multivariate analysis indicated a potential lowest-risk interval between 1 and 3 months post-VAD implantation.
Conclusions:
- The time interval from VAD insertion to cardiac transplantation significantly influences post-transplant survival.
- Performing transplantation within 2-4 weeks of VAD implantation is associated with significantly lower survival.
- A specific interval post-VAD implantation may represent a period of reduced risk for cardiac transplantation.
Objective:
We sought to determine the influence of the interval from ventricular assist device implantation to cardiac transplantation on end-organ function and posttransplantation survival.
Methods:
United Network for Organ Sharing data on 2692 heart transplantations performed in adult patients in the United States between October 1999 and March 2001 were reviewed.
Results:
Seventeen percent (466) of adult heart transplant recipients were bridged to transplantation with a ventricular assist device. Almost half of patients with ventricular assist devices undergoing transplantation were upgraded to status 1A as a result of ventricular assist device-related complications occurring more than 30 days after ventricular assist device implantation. Creatinine and total bilirubin levels were less in patients undergoing transplantation after 2 to 4 weeks of mechanical support. One-year survival was higher in the nonventricular assist device than in the ventricular assist device group (85.7% vs 79.7%, P =.0004). Within the ventricular assist device group, survival was lower for patients undergoing transplantation within 2 weeks of ventricular assist device implantation compared with those undergoing transplantation later (74.2% vs 84.2 %, P =.03). One-year survival among patients supported with a ventricular assist device for more than 30 days without complications was 91.4%. Multivariate analysis demonstrated a significant independent effect of the time interval from ventricular assist device implantation to transplantation on posttransplantation mortality and suggested that a period of lowest risk might exist between 1 and 3 months after implantation.
Conclusions:
Survival after cardiac transplantation is influenced by the time interval from ventricular assist device insertion to transplantation. Survival is significantly lower when performed within 2 to 4 weeks of ventricular assist device implantation.
