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HVAD versus heartmate III bridge to heart transplantation: Waitlist and posttransplant outcomes
Nicholas R Hess1, Lucas Witer2, Marc R Katz2
1Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Insights
Posttransplant survival is similar for patients receiving either the Heartware HVAD or Heartmate 3 (HM3) device as a bridge to heart transplantation. However, HM3 patients had a lower chance of receiving a transplant, possibly due to policy changes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Left ventricular assist devices (LVADs) are crucial for patients awaiting heart transplantation.
- Comparing outcomes between different LVADs, such as Heartware HVAD and Heartmate 3 (HM3), is essential for optimizing patient care.
- Understanding the impact of bridging devices on transplant candidacy and post-transplant outcomes is critical.
Purpose of the Study:
- To compare waitlist and post-transplant outcomes for patients bridged to orthotopic heart transplantation (OHT) with either the Heartware HVAD or Heartmate 3 (HM3) device.
- To analyze the influence of bridging device choice on transplant eligibility and survival rates.
- To evaluate the impact of recent heart allocation policy changes on device utilization and patient outcomes.
Main Methods:
- Utilized the United Network of Organ Sharing (UNOS) registry for data analysis.
- Conducted two separate analyses: waitlist outcomes (1/1/2015-3/20/2020) and post-transplant survival (1/1/2015-3/20/2020).
- Compared outcomes between adult, isolated OHT candidates bridged with HVAD or HM3 devices.
Main Results:
- A higher cumulative incidence of OHT at 1 year was observed in the HVAD cohort compared to the HM3 cohort.
- Yearly utilization of HM3 devices increased, while HVAD utilization decreased during the study period.
- HM3-bridged recipients experienced shorter waitlist times but longer graft cold ischemic times and a higher rate of post-transplant dialysis; however, post-transplant mortality rates were similar between groups.
Conclusions:
- Post-transplant survival is equivalent irrespective of the bridging device (HVAD or HM3).
- Patients bridged with HM3 had a lower likelihood of reaching transplantation, potentially reflecting recent heart allocation policy shifts.
- The choice of bridging device may influence transplant candidacy, necessitating further investigation into allocation policies.
Background:
This study compared outcomes of patients bridged with either the Heartware HVAD or Heartmate 3 (HM3) device to orthotopic heart transplantation (OHT).
Methods:
The United Network of Organ Sharing registry was queried to perform two separate analyses of adult, isolated OHT candidates bridged with HVAD or HM3. First, waitlist outcomes were compared among patients waitlisted 1/1/2015-3/20/2020. Second, posttransplant survival was compared among those transplanted 1/1/2015-3/20/2020.
Results:
Two thousand two hundred fifty-five candidates were waitlisted within the study period, 1587 (70.4%) bridged with HVAD and 668 (29.6%) with HM3. At 1 year from waitlisting, cumulative incidence of OHT higher in the HVAD cohort (p < .001). During the same time period, 2643 patients underwent OHT, 2154 (81.5%) with prior HVAD and 489 (18.5%) with HM3. Yearly proportions of patients bridged with HM3 increased across the study period and decreased for HVAD (p < .001). HM3-bridged recipients had shorter waitlist times, longer graft cold ischemic times, and experienced a higher rate of posttransplant dialysis requirement. Unadjusted and risk-adjusted posttransplant mortality rates were similar between both groups.
Conclusions:
Posttransplant survival is equivalent regardless of device type used for bridging. However, HM3 patients had lower likelihood of reaching transplantation, which may be a reflection of the recent heart allocation policy changes.
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