Prolonged continuous-flow left ventricular assist device support and posttransplantation outcomes: A new challenge

Objective To assess outcomes after cardiac transplantation in patients receiving long-term continuous-flow left ventricular assist device (CF-LVAD) support. Methods The United Network of Organ Sharing Database was used to identify 7808 heart transplant recipients between January 2011 and March 2014, 2456 (31.5%) of whom were bridged with CF-LVAD. Recipients were stratified by CF-LVAD duration: group 1, <1 year (n = 1590; 64.7%); group 2, 1 to 2 years (n = 599; 24.4%); and group 3, >2 years (n = 267; 10.9%). Results Compared with patients in groups 1 and 2, patients in group 3 spent more time as status 1A, had a greater body mass index and higher serum creatinine level, more often received blood transfusions and antibiotics, and more often developed device-related infection and life-threatening arrhythmia before transplantation. Kaplan-Meier analysis revealed statistically significant lower survival rates in group 3 compared with groups 1 and 2, at both 30 days (92.9% vs 96.4% vs 95.5%; group 1 vs group 3, P =.009) and 2 years (78.9% vs 88.2% vs 86.3%; group 1 vs group 3, P =.001) posttransplantation. Multivariable analyses identified duration of CF-LVAD support as a significant factor for 2-year posttransplantation mortality (hazard ratio, 1.16; 95% confidence interval, 1.01-1.34; P =.040). Conclusions A bridge-to-transplant (BTT) strategy with a CF-LVAD has become standard care for patients with advanced heart failure. Duration of CF-LVAD support is associated with increased midterm mortality, warranting early transplantation in the modern BTT era.