Survival Outcomes with Regards to Implant Strategies in Heart Transplantation

Purpose Strategies underlying the use of Left ventricular assist devices (LVAD) for patients with end-stage heart failure include its use as bridge to transplant (BTT) or as destination therapies (DT). Survival outcomes of patients undergoing these LVAD implant strategies were evaluated and compared. Methods A retrospective analysis of single center database heart transplant patients that received LVADs from Nov. 2009 to Sep. 2020 (n=137). Patients were placed into the following cohorts based on the implant strategy: 1) BTT (n=31), 2) DT (n=106). Demographics were compared between groups for significance. Kaplan Meier curves were calculated and compared via log rank tests, and Cox Regression Analysis was performed. P-values Results Demographics between the groups were: diagnosis (p=0.257), CPB time (p=0.957), XC time (p=0.763), ischemic time (p=0.478), warm ischemic time (p=0.332), age (p=0.323), race (p=0.067), length of stay (p=0.355) and PRA (p=0.701). Of 137 patients that received LVADs used for BTT or DT prior to heart transplant, the BTT group had better survival outcomes than DT (p=0.0467). Median survival time for DT group was 2554 days, and median survival time for BTT group was 3030 days. The type of LVADs used between the two groups were significantly different (p=0.0009), therefore cox regression was run to control for statistically significant variables, with device showing no significant effect on survival. In cox regression BTT had a protective effect over DT with a hazard ratio of 1.439, p=0.0364. Conclusion Implant strategies for LVAD as BTT or DT show a difference in survival outcomes for end-stage heart failure patients, however both had reasonable outcomes. This paper supports the current literature in that LVADs are viable for use in patients of all types, with slightly better effects in BTT patients.