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Destination LVAD therapy in the current era of the heart transplant allocation system

Saleem Toro1, Kelsey Patel, Ashrith Guha

  • 1Houston Methodist Debakey Cardiology Associates, Houston, Texas, USA.

Current Opinion in Cardiology
|April 5, 2023
PubMed

Insights

The 2018 heart transplant allocation system improved equity but introduced challenges like longer ischemic times and increased temporary support use. Future advancements in technology and AI may help manage these complications in advanced heart failure patients.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Medical Technology

Background:

  • The 2018 heart allocation system aimed to enhance equity and prioritize high-risk patients for heart transplantation.
  • While reducing wait-list mortality, the system introduced challenges including increased ischemic times and a shift towards temporary mechanical support over durable Left Ventricular Assist Devices (LVADs).
  • Advancements in LVAD technology and outcomes add complexity to shared decision-making for advanced heart failure patients.

Approach:

  • This review discusses the outcomes and complications of the new heart allocation system.
  • It examines the impact on patient care, including ischemic time and mechanical support utilization.
  • The review suggests strategies for preventing and managing challenges associated with the allocation system and LVADs.

Key Points:

  • The new allocation system has led to increased use of temporary mechanical support at the expense of durable LVADs.
  • Worsening ischemic times are a noted complication, impacting patient care post-allocation.
  • Shared decision-making is increasingly complex due to LVAD technological advancements and improved patient outcomes.

Conclusions:

  • The LVAD patient population is projected to grow, potentially increasing wait times and complication rates.
  • Emerging technologies like wireless devices and remote monitoring offer promising solutions for patient management.
  • Artificial intelligence holds potential for improving patient selection, early complication detection, and management strategies.
Abstract

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