Progression to Transplant under New Heart Allocation System: The Society of Thoracic Surgeons Intermacs Database.

Abstract: Background Under the new heart allocation policy, durable left ventricular assist devices receive lower priority on the transplant list. We sought to identify predictors of successful heart transplant after durable device implant as a means to inform patient care in the current era. Methods All patients (n=25,164) undergoing primary durable left ventricular device implant in the Society of Thoracic Surgeons Intermacs database (2010-2019) were evaluated. Patients identified as bridge to transplant (BTT, n=5242) or bridge to candidacy (BTC, n=6248) were analyzed with the endpoint of transplant before (n=10,588) and after (n=902) the change in the heart allocation system on October 18, 2018. Multivariable hazard modeling was used to assess risk-adjusted time to event associations. Results Of 11,490 patients, 45.5% progressed to transplant, (BTT 53.0%, BTC 36.6%), most by 14 months post LVAD. Under the new allocation system, progression to transplant was significantly lower at 14 months (18.6% vs. 34.8%, p Conclusions Despite having priority in the previous allocation system, less than half of BTT/BTC patients progressed to transplant. Under the current system, these numbers are further reduced. Heart teams should consider the implications of longer wait times with a durable left ventricular assist device when determining the optimal bridging strategy.