Heart Transplant Survival Rates in Patients Requiring a Ventricular Assist Device as a Bridge to Transplant

Background: Ventricular assist devices (VAD) are increasingly used as a bridge to transplant (BTT). However there are conflicting data regarding the post heart transplantation outcomes in patients who require this form of mechanical circulatory support (MCS). These patients are typically more unwell pre transplant which may adversely affect their survival post transplantation. We aimed to compare our institutions post-heart transplant survival rates in VAD BTT and non VAD BTT patients. Method: We performed a retrospective analysis of patients receiving heart transplantation during period 2003–2012 and compared outcomes for those requiring pre transplant VAD insertion to those who did not. The survival rates were estimated with the Kaplan–Meier method. Result: Heart transplant was performed in 132 patients. The median follow-up duration was 72 months. 29/132 (22%) patients required VAD as BTT (age: 42.4 ± 14.9 years). Of these, 16/29 (55%) patients required LVAD support (nine Thoratec PVAD, five Ventrassist and two HeartWare) and 13/29 (45%) required BiVAD support (12 Thoratec PVAD and one Abiomed AB5000). 103/132 (78%) did not require VAD BTT support (age: 46.4 ± 13.9 years). There was no significant difference in long-term post-transplant survival rates between those who required VAD BTT support and those who did not. The estimated one, three and five years survival rates were: 93% vs 90%, 88% vs 89% and 88% vs 86% respectively (p-value = 0.96). Conclusion: Patients who required VAD BTT support had good post-heart transplant survival rates that were comparable to those who did not require VAD support.