Evolving Results in Post-VAD Heart Transplantation

Objectives: Due to the scarcity of donor heart to meet the recipient demands, an increasing number of heart transplantations (HTx) are performed in patients bridged to transplantation with a ventricular assist device (VAD).

The objective of this study was to compare survival differences in orthotopic heart transplantation in patients with and without mechanical support over three consecutive periods in time.

Methods: Survival data were studied for patients who underwent HTx at our institution. The results were stratified with regards to one of three different time periods: group I procedures performed prior to 2000; group II procedures performed between 2000 and 2013; and group III procedures performed since 2013.

Patients in whom myocardial preservation was achieved using an ex vivo perfusion systems were excluded from the analysis.

Survival distributions between VAD- and non-VAD patients were compared using the log rank test.

Results: A total of 1,930 patients were included into the analysis.

The percentage of patients with VAD at HTx was 14.7% in group I, 39.3% in group II, and 55% in group III, respectively.

In group I, 5-year survival was 55.3% for VAD patients (n = 159) and 60.0% for non-VAD patients (n = 920); p = 0.438. In group II, 5-year survival was 66.1% for VAD patients (n = 254) and 61.1% for non- VAD patients (n = 391); p = 0.143. In group III, 5-year survival was 81.7% for VAD patients (n = 70) and 76.3% for non-VAD patients (n = 58); p = 0.067.

Overall survival increased significantly over time; p < 0.005.

Conclusion: While more and more patients underwent Htx, post-VAD support survival rates after HTx improved continuously. Despite the more challenging procedure, posttransplant survival in VAD patients is not inferior to non-VAD patients.

No conflict of interest has been declared by the author(s).