Studies have recently highlighted the conflicting results regarding the effects in the use of Ventricular assist devices (VADs), as a bridge to heart transplantation (BTT) especially on the post-transplant outcomes. Addressing this issue, Dr. N Selimovic and coworkers performed the present study of their single centre experience that compared patients who underwent VADs with the patients who underwent heart transplantation (HTx) during the same period.
Study population consisted of 71 consecutive patients who received 73 VADs at researchers University Hospital (among them 68 accepted to receive a BTT had mean age 40 ± 18 years, and 15 % were females; remaining 3 were accepted for a destination therapy) from January 1997 through December 2011. These patients were compared with 40 matched controls, who underwent heart transplantation (HTx) during the same period.
Among the 68 patients, VAD implanted were as follows: 86 % had left-VAD; 11% had bi-VAD; and in 3% it was right-VAD. 2 patients were implanted with a total artificial heart.
Findings from this study showed 14 patients with VADs (16%) implanted had died, 3 patients recovered with device explanation and 51 patients were bridged with VADs to HTx. 133 days (range 3-1002 days) of median duration of VAD support was reported.
Additionally, it was found that the actual mortality on device support was 14 % while 46% of patients underwent an HTx. 40 non-bridged transplanted patients (mean age 45±16 years, 10% female) were compared. Similar 1, 3, and 5 years survival was reported between VADs patients and controls after HTx (1 yr survival; 84 vs. 92%, p=0.14; 3 yrs survival; 79 vs. 83%, p=0.11; 5yrs survival: 75 vs. 74 %, p=0.3, Figure)
Figure: 1, 3, and 5 years survival among Ventricular assist devices patients and controls after heart transplantation
In conclusion this study demonstrated that mechanical circulatory support as bridge to heart transplantation results in excellent post-transplant outcomes and the survival was similar to non- bridge to heart transplantation patients.