The Impact of Prolonged Pre-Heart Transplantation Left Ventricular Assist Device on Post-Transplantation Outcomes

Background Durable mechanical circulatory support with a left ventricular assist device (LVAD) serves as bridge to heart transplantation (HTx) in patients with advanced heart failure. LVAD therapy is associated with improved outcomes, but has inherent limitations, including device-related complications. In this study, we aimed to evaluate the impact of prolonged LVAD support in patients who underwent HTx as compared to those without LVAD support. Method We retrospectively analysed 148 HTx recipients at University Medical Center Groningen, the Netherlands (2007–2023): 52 with prior LVAD support and 96 direct HTx patients. Outcomes included post-HTx survival, rejection requiring treatment, 1-year cardiac haemodynamics, and need for kidney replacement therapy. Results Median LVAD duration was 757 days (range 16–2,113). The LVAD group had fewer females (21% vs 54%; p<0.001). After a median 3.5-year follow-up, post-HTx survival was similar between groups (hazard ratio 0.83; 95% confidence interval 0.40–1.6; p=0.52). No significant differences were observed in the incidence of rejection requiring therapy (p=0.91) nor need for kidney replacement therapy (p=0.05–0.42). At 1-year post-HTx, the LVAD group showed modestly elevated pulmonary capillary wedge pressure (12.7 vs 10.6 mmHg; p=0.03) and reduced cardiac index (3.0 vs 3.3 L/min/m 2 ; p=0.03) compared to direct HTx recipients. Conclusions Prolonged LVAD support as bridge-to-transplantation showed no statistically significant differences with direct HTx in terms of post-HTx survival, rejection rates, and renal function despite minor differences in 1-year haemodynamic parameters.