Ventricular Assist Device Utilization in Heart Transplant Candidates: Nationwide Variability and Impact on Waitlist Outcomes.

Published

Journal Article

BACKGROUND:Continuous-flow left ventricular assist devices (CF-LVADs) have become a standard treatment choice in advanced heart failure patients. We hypothesized that practice patterns with regards to CF-LVAD utilization vary significantly among transplant centers and impact waitlist outcomes. METHODS AND RESULTS:The United Network for Organ Sharing registry was queried to identify adult patients who were waitlisted for heart transplantation (HT) between 2008 and 2015. Each patient was assigned a propensity score based on likelihood of receiving a durable CF-LVAD before or while waitlisted. The primary outcomes of interest were death or delisting for worsening status and HT at 1 year. A total of 22 863 patients from 92 centers were identified. Among these, 9013 (39.4%) were mechanically supported. CF-LVAD utilization varied significantly between and within United Network for Organ Sharing regions. Freedom from waitlist death or delisting was significantly lower in propensity-score-matched patients who were mechanically supported versus medically managed (83.5% versus 79.2%; P<0.001). However, cumulative incidence of HT was also lower in mechanically supported patients (53.3% versus 63.6%; P<0.001). Congruous mechanical and medical bridging strategies based on clinical risk profile were associated with lower risk of death or delisting (hazard ratio, 0.88; P=0.027) and higher likelihood of HT (hazard ratio, 1.14; P<0.001). CONCLUSIONS:CF-LVAD utilization may lower waitlist mortality at the expense of lower likelihood of HT. Decision to use CF-LVAD and timing of transition should be individualized based on patient-, center-, and region-level risk factors to achieve optimal outcomes.

Full Text

Duke Authors

Cited Authors

  • Truby, LK; Garan, AR; Givens, RC; Takeda, K; Takayama, H; Trinh, PN; Yuzefpolskaya, M; Farr, MA; Naka, Y; Colombo, PC; Topkara, VK

Published Date

  • April 2018

Published In

Volume / Issue

  • 11 / 4

Start / End Page

  • e004586 -

PubMed ID

  • 29666073

Pubmed Central ID

  • 29666073

Electronic International Standard Serial Number (EISSN)

  • 1941-3297

International Standard Serial Number (ISSN)

  • 1941-3289

Digital Object Identifier (DOI)

  • 10.1161/CIRCHEARTFAILURE.117.004586

Language

  • eng