Left Ventricular Assist Device Exchange Increases Heart Transplant Wait-List Mortality

Area of Science:

• Cardiology
• Transplantation Medicine
• Medical Device Engineering

Background:

• Current heart transplant allocation criteria may disadvantage patients with durable left ventricular assist devices (LVADs) requiring device exchange.
• This study investigates the impact of LVAD exchange on wait-list mortality.

Purpose of the Study:

• To evaluate if heart transplant candidates requiring LVAD exchange should receive higher priority.
• To assess the effect of LVAD exchange on wait-list mortality and transplant outcomes.

Main Methods:

• Retrospective observational study of 13,113 adult heart transplant candidates.
• Analysis of Organ Procurement and Transplantation Network data from 2007-2017.
• Evaluation of the impact of LVAD exchange on the composite endpoint of death or wait-list removal within one year.

Main Results:

• 1,085 pump exchanges occurred in 954 patients (7% of candidates).
• One-year survival was significantly lower for patients requiring LVAD exchange (76.3% vs. 88.5%).
• LVAD exchange was associated with a 2.56-fold increased risk of 1-year mortality.

Conclusions:

• Undergoing LVAD exchange doubles the risk of 1-year mortality for heart transplant candidates.
• Prioritizing patients with durable LVADs who require device exchange may reduce wait-list mortality.
• Revising allocation criteria could improve survival rates for high-risk transplant candidates.