Key result
Rising Impella bridge use post-allocation reform shows no change in 90-day post-transplant survival.
Why the study?
The 2018 US heart transplant allocation system change increased short-term mechanical circulatory support use, prompting an analysis of device use patterns and clinical outcomes.
Does the shifting landscape of temporary mechanical circulatory support bridging, particularly the increased use of microaxial flow pumps (Impella), impact 90-day post-transplant survival under the new US heart allocation system?
Cohort (n=5,325)
Yes
Does the shifting landscape of temporary mechanical circulatory support bridging, particularly the increased use of microaxial flow pumps (Impella), impact 90-day post-transplant survival under the new US heart allocation system?
Hazard Ratio: 0.95 (95% CI 0.73–1.25)
Absolute Event Rate: 94.8% vs 95%
p-value: p=.73
Since the 2018 change in the US heart transplant allocation system, temporary mechanical circulatory support, particularly the Impella device, has largely replaced durable VADs as a bridging strategy, without compromising 90-day post-transplant survival.
Stable short-term survival despite rising Impella bridging warrants no practice change; leaves open optimal device selection under revised allocation.
Objective: The 2018 change in the US heart transplant allocation system was associated with a significant increase in the use of short-term mechanical circulatory support. Using a large national database, we aimed to analyze changes in mechanical circulatory support device use and clinical outcomes after the allocation change. Methods: According to the United Network for Organ Sharing database, 5325 adult patients were identified who underwent heart transplantation in 2019 or 2024 (2019: n = 2226; 2024: n = 3099). Mechanical circulatory support type at registration and transplant, patient demographics, and 90-day unadjusted and adjusted survival were compared between the groups. Results: = .27) in both years. Conclusions: Since the adoption of the new allocation system, there has been a dramatic increase in the use of Impella devices. Overall and device-specific survival remain unchanged.
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Potel et al. (2026) conducted a cohort in Advanced heart failure requiring heart transplantation (n=5,325). Heart transplantation under mature new allocation system (2024 cohort) vs. Heart transplantation during early new allocation system (2019 cohort) was evaluated on 90-day overall survival (adjusted HR 0.95, 95% CI 0.73-1.25, p=.73). Following the US heart allocation reform, use of Impella devices for bridging significantly increased by 2024, while 90-day adjusted post-transplant survival remained unchanged (adjusted HR 0.95).
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