Abstract
The angiotensin receptor-neprilysin inhibitor, sacubitril-valsartan (SV), is indicated in patients with heart failure with reduced ejection fraction. The use of SV reduced the risk of death and of hospitalization for heart failure as compared to enalapril therapy in outpatients with NYHA class II-III symptoms. This study aimed to assess the outcomes of heart transplant candidates receiving SV at listing. All candidates listed for transplantation between January 2018 and March 2019 on the French registry CRISTAL were included. Candidates on VA-ECMO, long-term MCS and inotropic support at listing were excluded. Patients receiving SV at listing (study group, n=151) were compared to patients not receiving SV (control group, n=249). The main outcome was 6-month waitlist mortality or delisting for worsening medical condition. The secondary outcomes were 6-month rates of hospitalization and need for circulatory support. Survival curves were estimated using the Kaplan-Meier method. Association of SV use with the main outcome was evaluated with multivariable Cox proportional hazards model. Patients from the study group were older and more likely to have dilated or ischemic cardiomyopathy. They had lower glomerular filtration rate, NT-proBNP concentration and serum bilirubin level. Their 1-year access to transplantation was significantly lower (56% vs 71%, p=0.003). The 6-month survival rate tended to be higher in the study group (95.2% vs 89.3%, p=0.11). In the multivariable Cox model, lack of SV use was non significantly associated with higher 6-month waitlist mortality (HR 1.9; p = 0.2). The 6-month rate of hospitalization and need for circulatory support did not differ between the groups. Use of SV at listing is frequent in contemporary heart transplant candidates without circulatory support. Our findings suggest that SV use may be associated with reduced risk of waitlist mortality without effect on hospitalization rate.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
