Patients Awaiting Heart Transplantation on HVAD Support for Greater Than 2 Years

Area of Science:

• Cardiology
• Medical Devices
• Transplantation

Background:

• Advanced heart failure patients often require long-term mechanical circulatory support (MCS) as a bridge to transplant (BTT) due to donor organ scarcity.
• The HeartWare ventricular assist device (VAD) system is utilized for sustained MCS.
• Understanding outcomes for patients on long-term VAD support is crucial for managing advanced heart failure.

Purpose of the Study:

• To evaluate the outcomes of patients supported by the HeartWare VAD system for over two years.
• To analyze adverse event rates and quality of life improvements in this long-term MCS cohort.
• To compare characteristics and transplant rates between long-term and shorter-term VAD recipients.

Main Methods:

• Analysis of data from the HeartWare BTT and continued access protocol trial.
• Identification of patients with over two years of MCS support (n=74).
• Comparison of demographic data, adverse event rates, quality of life scores (Kansas City Cardiomyopathy Questionnaire, EuroQOL-5D), and 6-minute walk test results between long-term and other cohorts.

Main Results:

• 19.4% of patients (74/382) had over two years of MCS, averaging 1,045 days on the HeartWare VAD.
• The long-term cohort showed lower rates of postimplant adverse events (bleeding, arrhythmia, infection, stroke, renal dysfunction, right heart failure).
• Significant improvements in quality of life scores and 6-minute walk distance were observed in the long-term group.

Conclusions:

• Long-term support with the HeartWare VAD system (over 2 years) is associated with reduced adverse events and enhanced patient quality of life.
• Despite a lower transplant rate, most long-term patients remain listed for transplantation and maintain improved quality of life.
• The HeartWare VAD system demonstrates feasibility for extended support in bridge-to-transplant patients.