Survival Outcomes Among Patients with Combined Left and Right Ventricular Assist Device as a Bridge to Heart Transplant

H. Calvelli¹, M. Abul. Kashem², M. Brown¹, K. Hanna¹, Y. Toyoda^3
1Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania ²Department of Cardiothoracic Surgery at Temple University Hospital, Philadelphia, Pennsylvania ³Temple University Hospital, Philadelphia, Pennsylvania

Purpose: Ventricular assist devices (VADs) provide a mechanical circulatory bridge to heart transplantation. Patients requiring both left (LVAD) and right (RVAD) VADs are prioritized on the transplant waitlist. However, their outcomes are poorly studied. We compared survival among patients with LVAD and RVAD to patients without right ventricular failure.

Methods: The Organ Procurement Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database was queried to identify patients ≥18 years old who received a heart transplant between 2013–2023. Patients who were transplanted after the heart allocation policy change in 2018 but listed prior to this change were excluded. Patients were stratified by VAD type: LVAD+RVAD, LVAD, or No VAD. Survival was assessed using Kaplan-Meier curves and log-rank tests. Multivariate analysis was performed with Cox proportional hazards regression to identify variables associated with survival. P-values < 0.05 were considered significant.

Results: Among 26577 patients who received a heart transplant from 2013–2023, 320 (1.2%) had LVAD+RVAD, 7304 (27.5%) had LVAD, and 18953 (71.3%) had No VAD at the time of listing. Patients with LVAD+RVAD were younger than patients with LVAD or No VAD (median 50 years vs 56 vs 57, P< 0.0001) and waited less time for a heart transplant (median 18.5 days vs 94 vs 46, P< 0.0001). These patients also had a longer post-operative length of stay (median 21 days vs 17 vs 16, P< 0.0001). Patients with LVAD+RVAD had worse short-term (P < 0.0001) and long-term (P=0.0017) survival post-transplant on Kaplan-Meier analysis. The Cox regression model (Table 1) showed that LVAD was associated with worse survival compared to No VAD (P=0.002). Other significant predictors of mortality in our multivariate analysis included older donor and recipient age, recipient BMI, use of ECMO, and elevated preoperative total bilirubin and creatinine.

Conclusion: Our findings demonstrate that while patients with a combined LVAD and RVAD tend to be younger and spend less time on the transplant waitlist, they also have worse post-transplant outcomes and increased mortality. Compared to patients with no VAD, those with only a LVAD also had worse survival, suggesting that both prior left ventricular failure and right ventricular failure may predict post-transplant mortality.

Identify the source of the funding for this research project: None