Impact of Heart Allocation Change on Selection and Adverse Events of Bridged-To-Transplant Durable Ventricular Assist...

The 2018 UNOS heart allocation reform significantly altered the waiting list priority for recipients of durable left ventricular assist devices (LVADs). We sought to compare the characteristics of patients who were bridge-to-transplant (BTT) or bridge-to-candidacy (BTC) with a durable LVAD before and after the UNOS allocation change.

Data was retrieved from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support. Adult patients implanted with a continuous-flow, fully magnetically levitated (CF-ML) LVAD as a BTT or BTC from August 2017 to December 2021 were included. The cohort was divided into PRE and POST allocation changes.

A total of 2275 patients were implanted with a CF-ML LVAD as a BTT or BTC [PRE 687 (30.2%), POST 1588 (69.8%)]. Patients with LVADs implanted POST allocation change were more likely to have diabetes (9.1% vs. 4.9%, p < 0.001), pulmonary hypertension (24.4% vs. 11.4%, p < 0.001), cerebrovascular disease (6.2% vs. 4.1%, p = 0.05), and chronic lung disease (10.6% vs. 3.8%, p < 0.001). Postoperatively, the PRE cohort was more likely to develop early ischemic strokes (4.8% vs. 2.8%, p = 0.01), late gastrointestinal bleeding (7.1% vs. 5.0%, p < 0.01), late device malfunction (1.9% vs. 0.8%, p < 0.01), and late hemorrhagic stroke (1.5% vs. 0.7%, p = 0.01). Early and late readmissions were significantly more common for the PRE cohort. Ninety-day and one-year survival did not differ between cohorts.

Despite a more significant comorbidity burden, patients who were supported with an LVAD as BTT after the allocation change were less likely to be re-hospitalized or have device-related adverse events.