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Published on: August 2, 2024
Impact of Continuous Flow Left Ventricular Assist Device on Heart Transplant Candidates: A Multi-State Survival
Massimiliano Carrozzini1, Tomaso Bottio1, Raphael Caraffa1
1Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy.
Insights
Continuous-flow left ventricular assist devices (LVADs) significantly improve survival for heart transplant (HTx) candidates. LVAD support offers a survival benefit compared to patients without durable mechanical support awaiting HTx.
Area of Science:
- Cardiology
- Mechanical Circulatory Support
- Transplantation
Background:
- End-stage heart failure necessitates advanced therapies like heart transplantation (HTx).
- Left ventricular assist devices (LVADs) serve as a bridge-to-transplant (BTT) option for eligible candidates.
- The impact of prolonged LVAD support on HTx outcomes requires thorough investigation.
Purpose of the Study:
- To evaluate the effect of continuous-flow LVADs on heart transplant candidates.
- To compare survival outcomes between LVAD recipients and non-recipients before and after HTx.
Main Methods:
- A retrospective analysis of 250 end-stage heart failure patients considered for HTx between 2012 and 2019.
- Patients were categorized into LVAD (BTT) and No-LVAD groups.
- Multivariate and multi-state survival analyses were performed to assess outcomes.
Main Results:
- LVAD implantation demonstrated a significant protective effect on pre-HTx survival (HR 0.01, p < 0.01).
- Post-HTx mortality and adverse events were comparable between LVAD and No-LVAD groups.
- Multi-state survival analysis revealed a lower probability of death for LVAD patients.
Conclusions:
- Utilizing LVADs as a bridge to transplant provides an overall survival advantage for heart failure patients.
- LVAD therapy is associated with improved survival compared to standard listing without durable support.
Abstract:
(1) Objectives: The aim of this study was to investigate the impact of the prolonged use of continuous-flow left ventricular assist devices (LVADs) on heart transplant (HTx) candidates. (2) Methods: Between January 2012 and December 2019, we included all consecutive patients diagnosed with end-stage heart failure considered for HTx at our institution, who were also eligible for LVAD therapy as a bridge to transplant (BTT). Patients were divided into two groups: those who received an LVAD as BTT (LVAD group) and those who were listed without durable support (No-LVAD group). (3) Results: A total of 250 patients were analyzed. Of these, 70 patients (28%) were directly implanted with an LVAD as BTT, 11 (4.4%) received delayed LVAD implantation, and 169 (67%) were never assisted with an implantable device. The mean follow-up time was 36 ± 29 months. In the multivariate analysis of survival before HTx, LVAD implantation showed a protective effect: LVAD vs. No-LVAD HR 0.01 (p < 0.01) and LVAD vs. LVAD delayed HR 0.13 (p = 0.02). Mortality and adverse events after HTx were similar between LVAD and No-LVAD (p = 0.65 and p = 0.39, respectively). The multi-state survival analysis showed a significantly higher probability of death for No-LVAD vs. LVAD patients with (p = 0.03) or without (p = 0.04) HTx. (4) Conclusions: The use of LVAD as a bridge to transplant was associated with an overall survival benefit, compared to patients listed without LVAD support.
