Impact of Bridge to Transplantation With Continuous-Flow Left Ventricular Assist Devices on Posttransplantation Mortality
Key result
LVAD bridge to transplantation linked to ~32% higher 1-year posttransplant mortality versus medical management.
- P<0.001
- n=5,486
Why the study?
Does bridge to transplantation with LVADs impact posttransplantation mortality in adult heart transplant recipients compared to medical management?
Population
5,486 adult, single-organ heart transplantation recipients transplanted between 2008 and 2015, identified…
Comparison
Bridge to transplantation with continuous-flow… vs Medical management.
Design
Cohort
Follow-up
Up to 5 years
Authors
Discussion
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Implication
Bridge to heart transplantation with an LVAD is associated with higher early posttransplantation mortality compared to medical management, especially in patients with renal dysfunction or higher BMI.
Key Points
- This study aims to assess the impact of left ventricular assist devices (LVADs) on mortality after heart transplantation.
- Analyzed data from 5486 adult heart transplant recipients from 2008 to 2015 using propensity matching.
- Utilized Kaplan–Meier survival estimates to evaluate 1- and 5-year mortality.
- Employed logistic regression to compare 1-year mortality odds between LVAD and medically managed groups.
- Mechanically bridged patients showed higher 1-year mortality rates at 9.5% compared to 7.2% in medically managed patients (P < 0.001).
- Increased 1-year mortality risk associated with glomerular filtration rates <60 mL·min−1·1.73 m−2 and body mass indexes >25 kg/m2.
- High-risk BTT patients had a 1-year mortality of 17.6%, compared to 10.4% for high-risk medically managed patients.
Study Design
Type
Cohort (n=5,486)
Multicenter
Yes
Structured PICO
Does bridge to transplantation with LVADs impact posttransplantation mortality in adult heart transplant recipients compared to medical management?
P
Population
5,486 adult, single-organ heart transplant recipients transplanted between 2008 and 2015, propensity matched for likelihood of LVAD at the time of transplant.
E
Exposure
Bridge to transplantation (BTT) with continuous-flow left ventricular assist devices (LVADs).
C
Comparator
Medical management (medically bridged to heart transplantation).
O
Outcome
1- and 5-year posttransplantation mortality.hard clinical
Main Result
Absolute Event Rate: 9.5% vs 7.2%
p-value: p=<0.001
Bridge to heart transplantation with an LVAD is associated with higher early posttransplantation mortality compared to medical management, especially in patients with renal dysfunction or higher BMI.
Cite This Study
Truby et al. (2019) conducted a cohort in Heart failure awaiting heart transplantation (n=5,486). Bridge to transplantation with left ventricular assist devices (LVADs) vs. Medical management was evaluated on 1-year mortality (p=<0.001). Bridge to transplantation with left ventricular assist devices was associated with higher 1-year posttransplantation mortality compared with medical management (9.5% vs 7.2%; P<0.001).