Survival After Heart Transplantation in Patients Bridged With Mechanical Circulatory Support

BACKGROUND The United Network of Organ Sharing (UNOS) heart allocation policy designates patients on ECMO or with nondischargeable, surgically implanted, nonendovascular support devices (TCS-VAD) to higher listing statuses. OBJECTIVES This study aimed to explore whether temporary circulatory support-ventricular assist devices (TCS-VAD) have a survival advantage over extracorporeal membrane oxygenation (ECMO) as a bridge to transplant. METHODS The UNOS database was used to conduct a retrospective analysis of adult heart transplants performed in the United States between 2005 and 2017. Survival analysis was performed to compare patients bridged to transplant with different modalities. RESULTS Of the 24,905 adult transplants performed, 7,904 (32%) were bridged with durable left ventricular assist devices (LVADs), 177 (0.7%) with ECMO, 203 (0.8%) with TCS-VAD, 44 (0.2%) with percutaneous endovascular devices, and 8 (0.03%) with TandemHeart (LivaNova, London, United Kingdom). Unadjusted survival at 1 and 5 years post-transplant was 90 +/- 0.4% and 77 +/- 0.7% for durable LVAD, 84 +/- 3% and 71 +/- 4% for all TCS-VAD types, 79 +/- 9% and 73 +/- 14% for biventricular TCS-VAD, and 68 +/- 3% and 61 +/- 8% for ECMO. After propensity-matched pairwise comparisons were made, survival after all TCS-VAD types continued to be superior to ECMO (p = 0.019) and similar to LVAD (p = 0.380). ECMO was a predictor of post-transplant mortality in the Cox analysis compared with TCS-VAD (hazard ratio 2.40; 95% confidence interval: 1.44 to 4.01; p = 0.001). CONCLUSIONS Post-transplant survival with TCS-VAD is superior to ECMO and similar to LVAD in a national database. (J Am Coll Cardiol 2020;75:2892-905) (c) 2020 by the American College of Cardiology Foundation.