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Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart
Published on: May 11, 2018
The changing landscape of temporary mechanical circulatory support devices in the new heart allocation system: A US
Koray N Potel1, Sean Nguyen1, Nolan McLaughlin1
1Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn.
Objective:
The 2018 change in the US heart transplant allocation system was associated with a significant increase in the use of short-term mechanical circulatory support. Using a large national database, we aimed to analyze changes in mechanical circulatory support device use and clinical outcomes after the allocation change.
Methods:
According to the United Network for Organ Sharing database, 5325 adult patients were identified who underwent heart transplantation in 2019 or 2024 (2019: n = 2226; 2024: n = 3099). Mechanical circulatory support type at registration and transplant, patient demographics, and 90-day unadjusted and adjusted survival were compared between the groups.
Results:
Compared with 2019, patients being registered for heart transplantation in 2024 were more likely to have an Impella device (26.4% vs 3.3%, P < .001). At the time of heart transplantation, 2024 patients were less likely to be on a durable ventricular assist device (19.8% vs 42.4%) or an intra-aortic balloon pump (23.5% vs 37.8%), whereas the proportion of patients on extracorporeal membrane oxygenation slightly increased (9.2% vs 6%) and those with the Impella drastically increased (35.3% vs 4.2%, P < .001). Unadjusted and adjusted 90-day survivals were similar in 2019 and 2024 (95% vs 94.8%, P = .92). Unadjusted and adjusted 90-day survivals were similar for patients on extracorporeal membrane oxygenation (92% vs 92%, P = .63), intra-aortic balloon pump (97% vs 96%, P = .63), or the Impella (97% vs 96%, P = .27) in both years.
Conclusions:
Since the adoption of the new allocation system, there has been a dramatic increase in the use of Impella devices. Overall and device-specific survival remain unchanged.
