Heart transplant waiting list implications of increased ventricular assist device use as a bridge strategy: A national analysis

The use of ventricular assist devices (VADs) as a bridge to heart transplant (HT) is increasing, while HT volume remains stagnant. This may portend longer waiting times and an otherwise more competitive environment for all patients on the HT waiting list. A retrospective analysis of patients who wer...

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Bibliographic Details
Published in:Artificial organs 2021-04, Vol.45 (4), p.346-353
Main Authors: Han, Jason J., Elzayn, Hadi, Duda, Matthew M., Iyengar, Amit, Acker, Andrew M., Patrick, William L., Helmers, Mark, Birati, Edo Y., Atluri, Pavan
Format: Article
Language:English
Subjects:
Bridge loads
bridge to decision
bridge to transplant
Death
Durability
heart transplant
Heart transplantation
Heart transplants
Mortality
Strategy
Ventricle
ventricular assist device
Ventricular assist devices
waiting list
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Summary:The use of ventricular assist devices (VADs) as a bridge to heart transplant (HT) is increasing, while HT volume remains stagnant. This may portend longer waiting times and an otherwise more competitive environment for all patients on the HT waiting list. A retrospective analysis of patients who were listed for HT in the United Network for Organ Sharing (UNOS) database from 2000 to 2015 was conducted. Mean waiting time, proportion of HT reception (%HT), proportion of death (%death), and proportion of waiting list removal (%removal) were calculated across three eras: Era 1 (2000‐2007), Era 2 (2008‐2011), and Era 3 (2012‐2015). During the study period, 29 728 patients successfully underwent HT. 19 127 (64.3%) were directly transplanted (direct HT); 4491 (15.1%) received VADs prior to listing as a bridge to decision (BTD); and 4593 (15.5%) received VADs after listing as a bridge to transplant (BTT). Across the three eras, the average number of registrants per year grew. Among all groups, waiting time increased across the eras. %HT generally decreased in the BTD and BTT groups but remained constant in the direct HT group. %removal increased, while %death decreased in all group across the eras. Waiting time for HT increased from 2000 to 2015. Patients with VADs as a bridge strategy experienced decreasing %HT and increasing %removal but stable survival. Improvements in VAD safety and durability will ensure their success as part of a bridge strategy to HT under the new UNOS allocation policy.
ISSN:0160-564X
1525-1594
DOI:10.1111/aor.13833