Does Type of Mechanical Circulatory Support as Bridge to Heart Transplant Affect Outcomes?

Abstract

Purpose Bridge to transplant (BTT) with left ventricular assist device (LVAD) is associated with repeat sternotomy, risk of adverse events, and allosensitization. Consequently intra-aortic balloon pump (IABPs) have been increasingly used as BTT despite a paucity of data comparing the two strategies. We aim to compare pre- and post- heart transplant (HTx) outcomes in patients supported by LVAD and IABP as BTT. Methods This retrospective cohort study included all patients BTT by LVAD (n=115) and IABP (n=32) at a single medical center between 7/2010 and 4/2018. Results Twenty-three (20%) patients bridged with LVAD and 3 (9%) bridged with IABP died on the waiting list (p=0.03), whereas 83 (72%) LVAD patients and 23 (72%) IABP patients underwent HTx after 373 (median, IQR 184;743) and 18 (12;31) days of support, respectively. Six (19%) patients with IABP crossed over to LVAD. Patients BTT with LVAD had higher weight (86.3 +/- 20.5 vs 77.7 +/- 16.5, p=0.05) and albumin (3.7 +/- 1.5 vs 2.9 +/- 0.5, p Conclusion BTT with IABP compared to LVAD was associated with longer post-HTx hospital stay, lower rejection score, similar renal function, and similar short-term survival. Additional studies are needed to compare these two strategies with respect to patient outcomes as well as overall cost effectiveness.