Bridging to transplant with HeartMate 3 left ventricular assist devices in the new heart organ allocation system: An individualized approach. Academic Article uri icon

Overview

abstract

  • BACKGROUND: Following the MOMENTUM 3 trial and the discontinuation of the HeartWare HVAD, the HeartMate 3 LVAD (HM 3) has become the main durable device for bridging to transplantation; however, outcome of this strategy in the new heart allocation system is not well understood. METHODS: The United Network for Organ Sharing (UNOS) registry was queried to include adult patients (≥18 years old) listed for heart transplantation between 2010 and 2020. Trends in durable LVAD utilization and outcomes of patients with HM 3 LVAD were examined in the pre- vs post-heart allocation system. RESULTS: From 2017 to 2020, there was a 28.3% decline in the number of patients waitlisted with an FDA-approved durable LVAD. Overall, 449 patients were waitlisted with HM 3 in the pre-allocation era compared to 1094 patients in the post-allocation. Cumulative incidence of heart transplantation (53.4% vs 50.7%, p = 0.76) and death or delisting for worsening status (5.0%, vs 4.2%, p = 0.43) at 1-year after listing with HM 3 LVAD was comparable in the pre- vs post-allocation era. Old age (>50), ischemic HF, poor functional status, elevated creatinine (>1.3 mg/dL), pulmonary hypertension (>3 WU), and obesity (body mass index > 33 kg/m2) were predictors of post-transplant graft mortality after bridging with HM 3. CONCLUSIONS: While the utilization of durable devices as BTT have declined under the new heart allocation system, bridging with HM 3 LVAD remains a safe strategy in carefully selected patients. Bridging decision should be individualized based on patient risk factors.

publication date

  • September 10, 2022

Research

keywords

  • Heart Failure
  • Heart Transplantation
  • Heart-Assist Devices
  • Hypertension, Pulmonary

Identity

Scopus Document Identifier

  • 85140318026

Digital Object Identifier (DOI)

  • 10.1016/j.healun.2022.08.022

PubMed ID

  • 36272893

Additional Document Info

volume

  • 42

issue

  • 1