Outcome of heart transplantation after bridge-to-transplant strategy using various mechanical circulatory support devices.

Abstract

Orthotopic heart transplantation (OHT) is limited by a chronic shortage of donors. With the evolution of technology, more patients have been bridged to transplant (BTT) through various pathways using various types of mechanical circulatory support. We compared short- and long-term outcomes among these various strategies of BTT. We retrospectively reviewed 410 patients who had OHT between January 2009 and April 2015. Patients were divided into 4 groups according to BTT status: primary OHT without bridging (Group A, n = 246); bridge with implantable continuous-flow left ventricular assist device (CF-LVAD) (Group B, n = 130); bridge with short-term mechanical circulatory support (Group C, n = 16) and bridge with multiple mechanical circulatory supports, including short-term mechanical circulatory support and CF-LVAD (Group D, n = 18). Early and late outcomes after OHT were compared among the groups. The total duration of device support was 110.4 patient-years, 1.8 patient-years and 21.0 patient-years in Groups B, C and D, respectively. Patients who were bridged with CF-LVAD (Groups B and D) were more likely to have larger body size, blood type O, idiopathic dilated cardiomyopathy and ischaemic cardiomyopathy as an aetiology, lower total bilirubin level and longer waiting time on the United Network for Organ Sharing Status 1A. There was no statistical difference between the 4 groups in serum panel reactive antigen levels before OHT. Hospital mortality was 4% in Group A, 8% in Group B, 13% in Group C and 6% in Group D (P = 0.307). Post-transplant survival at 3 years was 80% in Group A, 82% in Group B, 75% in Group C and 88% in Group D (P = 0.752). BTT strategies using various mechanical circulatory support devices can provide comparable clinical outcomes to primary OHT. Flexibility in the use of both short-term mechanical circulatory support and CF-LVAD is necessary depending on the patient's background.