Left ventricular assist devices as a bridge to transplant strategy in a low organ donation environment: Single-center experiences

Background: In advanced heart failure patients, heart transplantation is currently the most effective treatment. However, in a low organ donation environment, it is usually necessary to proceed in long-term mechanical circulatory support through left ventricular assist device (LVAD) implantation as a bridge to transplantation.
Methods: This study included all patients with advanced heart failure who underwent continuous flow LVAD implantation as a bridge-to-transplant strategy in our centre (n = 68). Following implantation, pump thrombosis, strokes, gastrointestinal bleeding, and right heart failure occurrence rates were recorded. The outcomes were compared between patients who did reach heart transplantation (HTx group) and those who did not (noHTx group), as well as between patients implanted with HeartMate 3 (HM3) and HeartWare (hVAD) LVADs within 5 years following implantation.
Results: In total, 33 out of 68 patients underwent heart transplantation at a mean time of 691 ± 457 days. The noHTx group had significantly higher complication rates compared to the HTx group (p = 0.00041). Additionally, the LVAD related complication rates were higher in the patients implanted with hVAD compared to those with HM3 (p = 0.025). Heart transplantation did not confer a survival benefit in the specific time frame of the5 year follow-up. The five-year estimated survival rate following heart transplantation was 77%.
Conclusions: Patients with advanced heart failure gain substantial benefit from left ventricular assist devices when awaiting heart transplantation. In a low organ donation environment, the need for reliable left ventricular assist devices can further improve outcomes through the reduction of complications provided by current devices.

Keywords: heart failure; mechanical circulatory support; ventricular assist device; bridge-to-transplantation