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Updated: Feb 19, 2026
Optimization of the Cuff Technique for Murine Heart Transplantation
Published on: June 26, 2020
Outcome of heart transplantation after bridge-to-transplant strategy using various mechanical circulatory support
Daisuke Yoshioka1, Boyangzi Li1, Hiroo Takayama1
1Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA.
Insights
Bridging to transplant (BTT) strategies using mechanical circulatory support devices offer outcomes comparable to primary orthotopic heart transplantation (OHT). Tailoring support devices to patient needs is crucial for successful outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Biomedical Engineering
Background:
- Orthotopic heart transplantation (OHT) faces donor shortages.
- Mechanical circulatory support (MCS) enables bridging to transplant (BTT).
- Various MCS strategies exist for BTT.
Purpose of the Study:
- Compare short- and long-term outcomes of different BTT strategies.
- Evaluate the efficacy of continuous-flow left ventricular assist devices (CF-LVADs) and short-term MCS in OHT recipients.
- Assess patient characteristics associated with different BTT pathways.
Main Methods:
- Retrospective review of 410 OHT patients (2009-2015).
- Categorization into 4 groups: primary OHT, CF-LVAD bridge, short-term MCS bridge, and combined MCS bridge.
- Comparison of early and late post-transplant outcomes.
Main Results:
- No significant difference in 3-year post-transplant survival across groups (80-88%).
- CF-LVAD bridged patients (Groups B & D) had specific demographic and etiological profiles.
- Hospital mortality rates were comparable across all groups (4-13%).
Conclusions:
- BTT strategies with MCS devices yield outcomes comparable to primary OHT.
- Flexible application of short-term MCS and CF-LVAD is essential.
- Patient-specific approaches are key for optimizing BTT outcomes.
Objectives:
Orthotopic heart transplantation (OHT) is limited by a chronic shortage of donors. With the evolution of technology, more patients have been bridged to transplant (BTT) through various pathways using various types of mechanical circulatory support. We compared short- and long-term outcomes among these various strategies of BTT.
Methods:
We retrospectively reviewed 410 patients who had OHT between January 2009 and April 2015. Patients were divided into 4 groups according to BTT status: primary OHT without bridging (Group A, n = 246); bridge with implantable continuous-flow left ventricular assist device (CF-LVAD) (Group B, n = 130); bridge with short-term mechanical circulatory support (Group C, n = 16) and bridge with multiple mechanical circulatory supports, including short-term mechanical circulatory support and CF-LVAD (Group D, n = 18). Early and late outcomes after OHT were compared among the groups.
Results:
The total duration of device support was 110.4 patient-years, 1.8 patient-years and 21.0 patient-years in Groups B, C and D, respectively. Patients who were bridged with CF-LVAD (Groups B and D) were more likely to have larger body size, blood type O, idiopathic dilated cardiomyopathy and ischaemic cardiomyopathy as an aetiology, lower total bilirubin level and longer waiting time on the United Network for Organ Sharing Status 1A. There was no statistical difference between the 4 groups in serum panel reactive antigen levels before OHT. Hospital mortality was 4% in Group A, 8% in Group B, 13% in Group C and 6% in Group D (P = 0.307). Post-transplant survival at 3 years was 80% in Group A, 82% in Group B, 75% in Group C and 88% in Group D (P = 0.752).
Conclusions:
BTT strategies using various mechanical circulatory support devices can provide comparable clinical outcomes to primary OHT. Flexibility in the use of both short-term mechanical circulatory support and CF-LVAD is necessary depending on the patient's background.
