Heart transplantation after total artificial heart bridging-Outcomes over 15 years.

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Data are limited on outcomes after heart transplantation in patients bridged-to-transplantation (BTT) with a total artificial heart (TAH-t). The UNOS database was used to identify 392 adult patients undergoing heart transplantation after TAH-t BTT between 2005 and 2020. They were compared with 11014 durable left ventricular assist device (LVAD) BTT patients and 22348 de novo heart transplants (without any durable VAD or TAH-t BTT) during the same period. TAH-t BTT patients had increased dialysis dependence compared to LVAD BTT and de novo transplants (24.7%vs. 2.7%vs. 3.8%) and higher levels of baseline creatinine and total bilirubin (all p<.001). After transplantation, TAH-t BTT patients were more likely to die from multiorgan failure in the first year (25.0%vs. 16.1%vs. 16.1%, p=.04). Ten-year survival was inferior in TAH-t BTT patients (TAH-t BTT 53.1%, LVAD BTT 61.8%, De Novo 62.6%, p<.001), while 10-year survival conditional on 1-year survival was similar (TAH-t BTT 66.8%, LVAD BTT 68.7%, De Novo 69.0%, all p>.20). Among TAH-t BTT patients, predictors of 1-year mortality included higher baseline creatinine and total bilirubin, mechanical ventilation, and cumulative center volume <20 cases of heart transplantation involving TAH-t BTT (all p<.05). Survival after TAH-t BTT is acceptable, and patients who survive the early postoperative phase experience similar hazards of mortality over time compared to de novo transplant patients and durable LVAD BTT patients.