LVAD Bridge to Heart Transplantation Improves Posttransplant Survival

Patients who receive an implantable left ventricular assist device (LVAD) as a bridge to heart transplantation have better overall survival compared with patients treated with IV inotropes, researchers report in the April 17th issue of the Journal of the American College of Cardiology.

“There seems to be a trend that patients treated with LVAD therapy before heart transplantation seem to have improved outcomes compared to similar patients not treated by LVAD therapy,” Dr. Francis D. Pagani, from the University of Michigan, Ann Arbor, told Reuters Health.

“The reason for this is that LVAD therapy…improves kidney function and overall physical condition before heart transplantation,” he said.

Dr. Pagani and colleagues compared the survival of 104 patients who were bridged to heart transplantation with an implantable LVAD or with IV inotropes.

Among the 66 patients who received LVADs, 48 survived to transplantation compared with 28 of the 38 patients who received IV inotropes.

At 3 years after transplantation, survival was 95% (two deaths) among patients who received LVADs compared with 65% (nine deaths) among patients who had received IV inotropes. At 3 years from the onset of bridging support, overall survival was 77% for the LVAD group and 44% for the inotrope group (p = 0.01), the researchers note.

Dr. Pagani and colleagues conclude that “treatment with LVAD as a bridge to heart transplantation appears to yield significantly improved overall long-term survival and, importantly, conserves donor hearts.”

They add that “with longer waiting times to transplantation and improving trends in LVAD survival, LVAD therapy, as opposed to prolonged inotropic therapy, may be the preferred method of bridging to heart transplantation.”

In an accompanying editorial, Dr. Patrick M. McCarthy, from the Cleveland Clinic Foundation, envisions a time when there will be patients with LVADs waiting for “donor hearts that will not be expected to arrive.”

“In this scenario, the LVAD may end up being a permanent implant or destination therapy because the patient and physician have decided that the LVAD is safer than the morbidity and mortality of immunosuppression and transplantation,” Dr. McCarthy writes.

Dr. Pagani agreed. “As soon as pump technology gets a little bit better, LVAD may be a very viable option for long-term therapy, without transplantation,” he said.

J Am Coll Cardiol 2002;39:1247-1257.