Temporary Mechanical Circulatory Support, a New Paradigm in Bridging Patients to Heart Transplantation: Comparing Outcomes versus Durable Left Ventricular Assist Devices

Abstract

Purpose Use of a novel temporary mechanical support system in the axillary position has emerged as a successful method to bridge patients to heart transplantation (BTT). This system has advantages over durable left ventricular assist devices (LVAD) but comparative outcomes have not yet been evaluated. Methods Patients presenting from 2014-2018 with decompensated heart failure who required an axillary temporary LVAD as BTT were evaluated retrospectively. A comparison group of patients who underwent durable LVAD placement as BTT from the same time period was identified. Demographics and outcomes were evaluated and compared for each group. Results 47 patients underwent an axillary temporary LVAD placement and 92 patients had a durable LVAD placed for BTT. The majority of patients were Intermacs 1 or 2 (46.8% and 48.9%) for the temporary LVAD group, and Intermacs 2 or 3 (32.6% and 30.4%) for the durable LVAD group. Postoperative complications were higher in the durable group for GI bleeding 2.1% vs 14.1% (p=0.034) and stroke 4.3% vs 14.1% (p=0.089), and increased in the temporary group for renal failure at 28.9% vs 14.1% (p=0.062). All-cause mortality was not statistically different, 15.6% vs 13.0% (p=0.793). Thirty-day and 1-year survival post transplantation were nearly equivalent, 100% vs 100% and 94.4% vs 97.1% (p>0.999) respectively. Wait time on the transplant list was significantly longer for the durable LVAD group vs the temporary LVAD group and is shown in table 1. Conclusion Use of a novel temporary LVAD as a bridge to transplantation has excellent outcomes, which compare favorable to the established standard of durable mechanical circulatory support. These results challenge the established paradigm of mechanical support in bridging patients to heart transplantation in light of the new UNOS listing criteria changes. Further studies within the larger national patient population are required to confirm these findings. Use of a novel temporary mechanical support system in the axillary position has emerged as a successful method to bridge patients to heart transplantation (BTT). This system has advantages over durable left ventricular assist devices (LVAD) but comparative outcomes have not yet been evaluated. Patients presenting from 2014-2018 with decompensated heart failure who required an axillary temporary LVAD as BTT were evaluated retrospectively. A comparison group of patients who underwent durable LVAD placement as BTT from the same time period was identified. Demographics and outcomes were evaluated and compared for each group. 47 patients underwent an axillary temporary LVAD placement and 92 patients had a durable LVAD placed for BTT. The majority of patients were Intermacs 1 or 2 (46.8% and 48.9%) for the temporary LVAD group, and Intermacs 2 or 3 (32.6% and 30.4%) for the durable LVAD group. Postoperative complications were higher in the durable group for GI bleeding 2.1% vs 14.1% (p=0.034) and stroke 4.3% vs 14.1% (p=0.089), and increased in the temporary group for renal failure at 28.9% vs 14.1% (p=0.062). All-cause mortality was not statistically different, 15.6% vs 13.0% (p=0.793). Thirty-day and 1-year survival post transplantation were nearly equivalent, 100% vs 100% and 94.4% vs 97.1% (p>0.999) respectively. Wait time on the transplant list was significantly longer for the durable LVAD group vs the temporary LVAD group and is shown in table 1. Use of a novel temporary LVAD as a bridge to transplantation has excellent outcomes, which compare favorable to the established standard of durable mechanical circulatory support. These results challenge the established paradigm of mechanical support in bridging patients to heart transplantation in light of the new UNOS listing criteria changes. Further studies within the larger national patient population are required to confirm these findings.