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Heart Transplantation After Ventricular Assist Device Therapy: Benefits, Risks, and Outcomes

Nirvik Pal1, Samuel H Gay1, Charles G Boland1

  • 1Virginia Commonwealth University, Richmond, VA, USA.

Seminars in Cardiothoracic and Vascular Anesthesia
|January 14, 2020
PubMed

Insights

Left ventricular assist devices (LVADs) are increasingly used for advanced heart failure. This review examines the impact of prior LVAD support on outcomes following heart transplantation, considering both risks and benefits.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Mechanical Circulatory Support

Background:

  • Heart transplantation is a definitive treatment for end-stage heart failure.
  • Mechanical circulatory support, particularly left ventricular assist devices (LVADs), is increasingly utilized for advanced heart failure.
  • LVAD use has significantly increased, with a majority of heart transplant candidates now bridged with these devices.

Purpose of the Study:

  • To review the current literature on the outcomes of heart transplantation in patients previously supported by LVADs.
  • To evaluate the impact of pre-transplant LVAD support on post-transplant morbidity and survival.
  • To synthesize the risks and benefits associated with heart transplantation in LVAD-supported patients.

Main Methods:

  • Systematic review of existing medical literature.
  • Analysis of data from the United Network of Organ Sharing database (2006-2013) regarding LVAD usage.
  • Inference of outcomes based on pooled data and clinical evidence.

Main Results:

  • LVADs significantly improve survival for patients awaiting heart transplantation.
  • The effects of prior LVAD support on post-heart transplantation morbidity and long-term survival remain incompletely understood.
  • Available data suggests a complex interplay of factors influencing outcomes in this population.

Conclusions:

  • While LVADs are crucial for wait-list survival, their influence on heart transplant recipients requires further investigation.
  • Understanding the risks and benefits is essential for optimizing patient selection and management.
  • Further research is needed to clarify the long-term implications of LVAD support prior to heart transplantation.

Keywords:
heart failureheart transplantationleft ventricular assist devicesoutcomessurvival

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