LVAD as Bridge to Transplant Leads to Better Outcomes When Compared to Transplant-Only Strategy

Abstract

Background Patient who are bridged to transplantation with a left ventricular assist device (LVAD) when compared to primary heart transplantation have had mixed outcomes. Methods Single-center study of patients who underwent cardiac transplantation or LVAD implantation. Baseline demographics and outcomes were compared between 3 groups: patients bridged with a LVAD (BTT-LVAD group), patients who underwent primary cardiac transplantation (TXP group), and patients who underwent LVAD as destination therapy (DT-LVAD group). For the TXP group, survival was defined as days alive since cardiac transplantation. For the BTT-LVAD group, survival was defined from time of LVAD implantation and included days alive after cardiac transplantation. In the DT-LVAD group, survival was defined as days alive since LVAD implantation. Kaplan-Meier curves were used to analyze survival between the groups. Results A total of 380 patients were included (BTT-LVAD group: 36.3.%; TXP group: 26%; DT-LVAD group: 37.6%). At baseline, no significant differences with regards to age and BMI were noted. Male gender and blood type O were more common in the BTT-LVAD group. The DT-LVAD group had a higher proportion of black patients. During the study period, 76% of LVAD-BTT group underwent cardiac transplantation. A high survival rate was observed is the study population at 1-year (92.1%). Non-statistically significant differences in 1-year survival were noted between groups with higher trends of survival observed in the BTT-LVAD group (BTT-LVAD group: 95.7%; TXP group: 90.9%; DT-LVAD group: 89.5%, p=0.14). By 2 years, survival rates remained high in all groups with statistically significant differences noted among the groups (BTT-LVAD group: 94.6%; TXP group: 85.9%; DT-LVAD group: 81.4%, p=0.01). 3-year survival remained high for both the BTT-LVAD and TXP groups however, a decline in survival was noted in the DT-LVAD group (BTT-LVAD group: 93.5%; TXP group: 81.6%; DT-LVAD group: 60.8%, p=0.00). While 5-year survival remained high for the LVAD-BTT group (figure), a further survival decrease was observed in both the TXP and DT-LVAD groups (BTT-LVAD group:8 4.2%; TXP group: 63%; DT-LVAD group: 29.8%, p=0.00). Conclusions Our study showed an exceptionally high survival rate in patients bridged to cardiac transplantation with LVAD implantation. These findings also suggest that the use of a LVAD as a BTT may be a better strategy than primary cardiac transplantation as it may add an additional survival benefit (total support time).