Bridging to transplant with HeartMate 3 left ventricular assist devices in the new heart organ allocation system: An individualized approach

Following the MOMENTUM 3 trial and the discontinuation of the HeartWare HVAD, the HeartMate 3 LVAD (HM 3) has become the main durable device for bridging to transplantation; however, outcome of this strategy in the new heart allocation system is not well understood. The United Network for Organ Shar...

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Bibliographic Details
Published in:	The Journal of heart and lung transplantation Vol. 42; no. 1; pp. 124 - 133
Main Authors:	Uriel, Matan H., Clerkin, Kevin J., Takeda, Koji, Naka, Yoshifumi, Sayer, Gabriel T., Uriel, Nir, Topkara, Veli K.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-01-2023
Subjects:	Adolescent Adult guideline Heart Failure - etiology Heart Failure - surgery heart transplantation Heart Transplantation - adverse effects Heart-Assist Devices - adverse effects Humans Hypertension, Pulmonary - etiology left ventricular assist device Retrospective Studies Risk Factors Treatment Outcome heart transplantation guideline left ventricular assist device
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Summary:	Following the MOMENTUM 3 trial and the discontinuation of the HeartWare HVAD, the HeartMate 3 LVAD (HM 3) has become the main durable device for bridging to transplantation; however, outcome of this strategy in the new heart allocation system is not well understood. The United Network for Organ Sharing (UNOS) registry was queried to include adult patients (≥18 years old) listed for heart transplantation between 2010 and 2020. Trends in durable LVAD utilization and outcomes of patients with HM 3 LVAD were examined in the pre- vs post-heart allocation system. From 2017 to 2020, there was a 28.3% decline in the number of patients waitlisted with an FDA-approved durable LVAD. Overall, 449 patients were waitlisted with HM 3 in the pre-allocation era compared to 1094 patients in the post-allocation. Cumulative incidence of heart transplantation (53.4% vs 50.7%, p = 0.76) and death or delisting for worsening status (5.0%, vs 4.2%, p = 0.43) at 1-year after listing with HM 3 LVAD was comparable in the pre- vs post-allocation era. Old age (>50), ischemic HF, poor functional status, elevated creatinine (>1.3 mg/dL), pulmonary hypertension (>3 WU), and obesity (body mass index > 33 kg/m2) were predictors of post-transplant graft mortality after bridging with HM 3. While the utilization of durable devices as BTT have declined under the new heart allocation system, bridging with HM 3 LVAD remains a safe strategy in carefully selected patients. Bridging decision should be individualized based on patient risk factors.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1053-2498 1557-3117
DOI:	10.1016/j.healun.2022.08.022