Impact on mortality of heart transplantation preceded or not by continuous-flow left ventricular assist devices

Abstract

Abstract Background Heart transplant (HT) is the therapy of choice in end-stage heart failure patients. With the scarcity of donors, bridge to transplantation (BTT) with left ventricular assist device (LVAD) becomes an option in patients awaiting HT. Criteria for HT listing do not differ between patients medically managed and those mechanically bridged to HT. Objectives The objectives of the present study is to assess the survival following HT preceding or not with LVAD as BTT and to evaluate differences in risk factors for 4-year mortality between those with (LVAD +) and those without LVAD (LVAD -) at the time of HT. Methods Using the local database, we identified 145 heart-transplanted adults (LVAD +, n=28 and LVAD -, n=117) between 2000 and 2020. Patients were propensity matched for likelihood of LVAD at the time of HT. Kaplan-Meier survival estimates were used to assess the impact of BTT on 30-day and 4-year mortality. Logistic regression analysis was used to evaluate the odds ratio of 4-year mortality for patients BTT with LVAD compared with those with medical management across clinically significant variables at various thresholds. Results 30-day and 4-year post HT mortalities were similar in mechanically bridged patients or not: 10,7% versus 11,1% mortality (P=0,71), and 32,1% versus 35,9% mortality (P=0,61), respectively. Because outcomes were similar in both groups, risk factors for 4-year mortality were investigated in the total cohort of HT. Diabetes at the time of HT (CI [1.93–10.72], OR=4,55, p= 0.001), early post-HT hemorrhage (CI [2,01–15.23], OR=5,53, p= 0.001), and ventricular arrhythmia (CI [1.08–7,51], OR=2,84, p= 0.001) and late HT antidepressant drugs use (CI [0,02–0,51], OR=0,11, p= 0.005), incurred in the risk of 4-year mortality. Conclusions Bridge to HT with LVAD, although necessary because of organ scarcity and capable of improving wait list survival, confers no significantly risk of early and late posttransplantation mortality. Diabetes may require more careful consideration for transplant eligibility while antidepressant use are protective.Figure 1