Comparison of continuous flow centrifugal left ventricular assist devices as a bridge to transplant strategy in a low organ donation environment: Single center experience.

Abstract

Background: In advanced heart failure patients, heart transplantation is currently the most effective treatment. However, in a low-organ environment, it is usually necessary to proceed in long-term mechanical circulatory support through left ventricular assist device (LVAD) implantation as bridge-to-transplantation METHODS: The 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 LVAD implantation and for the period that patients were on LVAD support, pump thrombosis, strokes, gastrointestinal bleeding and right heart failure occurrence rates were recorded. Outcomes were compared between patients implanted with HeartMate 3 (HM3) and HeartWare (hVAD) LVADs as well as between patients who did reach heart transplantation (HTx group) and those who did not (noHTx group).

Results: 35 out of 68 patients underwent heart transplantation at a mean time of 691 ± 457 days. 41 patients received a HeartWare hVAD and 27 a HeartMate 3 (HM3) device. HM3 patients had significantly better survival (p = 0.010) and lower complication rates (p = 0.025). Additionally, the noHTx group had significantly higher complication rates compared to the HTx group (p = 0.00041). The five-year estimated Kaplan-Meier survival rates following heart transplantation was 77%.

Conclusions: Patients with advanced heart failure gain substantial benefit from left ventricular assist devices awaiting heart transplantation. In a low organ donation environment, the need for reliable left ventricular assist devices can further improve the outcomes through the reduction of complications provided by current devices.