Mortality Differences after Heart Transplantation in Patients Bridged with Balloon Pumps vs. Left Ventricular Assist Devices

Abstract

<h3>Purpose</h3> To evaluate survival following orthotopic heart transplantation (OHT) in patients supported with durable left ventricular assist devices (dLVAD) vs. intra-aortic balloon pumps (IABP) preoperatively. <h3>Methods and Materials</h3> Adult subjects undergoing primary OHT after mechanical circulatory support (MCS) from 1/2002 through 12/2011 were analyzed using the United Network for Organ Sharing (UNOS) database. Generalized linear models were used to assess postoperative mortality based on treatment with IABP or dLVAD at the time of listing and at transplant. <h3>Results</h3> 1,576 patients were analyzed. The IABP group (n=320) required more inotropic (63.8% vs. 8.7%, p<0.0001) and mechanical ventilatory support (1.4% vs. 0.5%, p<0.0001) but had shorter waitlist times (median 10 vs. 82 days, p<0.0001) than the dLVAD group (n=1259). The dLVAD group had lower mortality at 30-days [adjusted odds ratio (AOR) 0.60, 95% confidence interval (CI) 0.37-0.98, p=0.04], 90-days (AOR 0.65, CI 0.42-0.99, p=0.04), and 1-year (AOR 0.60, CI 0.38-0.96, p=0.03) when compared to the IABP group; however, long term survival was similar. [figure 1] <h3>Conclusions</h3> Data from UNOS suggests that despite shorter wait times, patients undergoing OHT following IABP support have higher inotropic and ventilatory support requirements at the time of transplantation and higher early postoperative mortality compared to those supported with dLVAD; however long-term survival is similar. The implications of organ selection, severity of illness, and the circumstances of MCS initiation require further investigation to determine an optimal algorithm for patients awaiting OHT who have failed inotropes.