Prolonged continuous-flow left ventricular assist device support and posttransplantation outcomes: A new challenge

Area of Science:

• Cardiology
• Transplantation Medicine
• Medical Devices

Background:

• Continuous-flow left ventricular assist devices (CF-LVADs) are standard for advanced heart failure patients awaiting transplantation.
• The impact of CF-LVAD support duration on post-transplant outcomes requires further investigation.

Purpose of the Study:

• To evaluate the association between the duration of CF-LVAD support and outcomes following cardiac transplantation.
• To identify risks associated with prolonged CF-LVAD use before heart transplant.

Main Methods:

• Utilized the United Network of Organ Sharing Database for 7808 heart transplant recipients (2011-2014).
• Stratified 2456 CF-LVAD recipients into three groups based on support duration: <1 year, 1-2 years, and >2 years.
• Employed Kaplan-Meier analysis and multivariable analyses to compare survival rates and mortality factors.

Main Results:

• Patients with CF-LVAD support >2 years (group 3) had higher rates of pre-transplant complications, including status 1A, higher creatinine, and infections.
• Kaplan-Meier analysis showed significantly lower 30-day and 2-year survival rates in group 3 compared to groups 1 and 2.
• Multivariable analysis identified longer CF-LVAD duration as a significant predictor of increased 2-year post-transplantation mortality.

Conclusions:

• Prolonged CF-LVAD support is associated with increased midterm mortality after heart transplantation.
• Current bridge-to-transplant strategies necessitate consideration of CF-LVAD duration.
• Early heart transplantation should be considered for patients on long-term CF-LVAD support to mitigate mortality risks.