Heart transplant with or without bridge to transplant left ventricular assist device (LVAD) therapy was found to be associated with greater 5-year survival compared with LVAD destination therapy in patients with end-stage heart failure (HF), according to a retrospective study in JAMA Cardiology.

In this propensity-matched retrospective analysis, the data of 8281 patients (ages, 18-75 years) with end-stage HF who were wait-listed for heart transplant or were implanted with an LVAD for advanced cardiomyopathy, were examined. Heart transplant data for the 2010 to 2014 period were obtained from the United Network for Organ Sharing registry (n=4867) and from the Interagency Registry for Mechanically Assisted Circulatory Support (n=3414). The study’s primary outcome of interest was survival at 5 years.

Patients who received LVAD destination therapy were older than patients wait-listed for heart transplant (64.0 vs 60.0 years, respectively; P <.001). The cohort was otherwise gender-balanced (P =.13). There were 3411 patients who were wait-listed for heart transplant after matching for age, sex, body mass index, renal function, and albumin level (n=1607 with bridge to transplant LVAD therapy; n=1804 without LVAD).

Wait-listing for heart transplant was associated with a better 5-year survival compared with LVAD destination therapy (72.1% vs 36.1%, respectively; risk ratio [RR], 0.42; 95% CI, 0.38-0.46; P <.001). The overall 1-year survival rates in patients wait-listed for heart transplant and in those with LVAD destination therapy were 87.7% vs 76.4%, respectively. Heart transplant status was associated with a survival advantage (adjusted RR for time-dependent transplant status, 0.27; 95% CI, 0.24-0.32).


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Limitations of the study include the lack of detailed information on criteria for destination therapy vs bridge to transplant.

“We believe our findings show that continued improvement in LVAD technology, along with prospective comparative research, is needed to amend this strategy,” concluded the study authors.

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Lala A, Rowland JC, Ferket BS, et al. Strategies of wait-listing for heart transplant vs durable mechanical circulatory support alone for patients with advanced heart failure [published online April 15, 2020]. JAMA Cardiol. doi:10.1001/jamacardio.2020.0631