• Shinichi Fukuhara, Koji Takeda, Antonio R Polanco, Hiroo Takayama, and Yoshifumi Naka.
• Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY.
• J. Thorac. Cardiovasc. Surg. 2016 Mar 1; 151 (3): 872-80.e1-5.

ObjectiveTo assess outcomes after cardiac transplantation in patients receiving long-term continuous-flow left ventricular assist device (CF-LVAD) support.MethodsThe United Network of Organ Sharing Database was used to identify 7808 heart transplant recipients between January 2011 and March 2014, 2456 (31.5%) of whom were bridged with CF-LVAD. Recipients were stratified by CF-LVAD duration: group 1, <1 year (n = 1590; 64.7%); group 2, 1 to 2 years (n = 599; 24.4%); and group 3, >2 years (n = 267; 10.9%).ResultsCompared with patients in groups 1 and 2, patients in group 3 spent more time as status 1A, had a greater body mass index and higher serum creatinine level, more often received blood transfusions and antibiotics, and more often developed device-related infection and life-threatening arrhythmia before transplantation. Kaplan-Meier analysis revealed statistically significant lower survival rates in group 3 compared with groups 1 and 2, at both 30 days (92.9% vs 96.4% vs 95.5%; group 1 vs group 3, P = .009) and 2 years (78.9% vs 88.2% vs 86.3%; group 1 vs group 3, P = .001) posttransplantation. Multivariable analyses identified duration of CF-LVAD support as a significant factor for 2-year posttransplantation mortality (hazard ratio, 1.16; 95% confidence interval, 1.01-1.34; P = .040).ConclusionsA bridge-to-transplant (BTT) strategy with a CF-LVAD has become standard care for patients with advanced heart failure. Duration of CF-LVAD support is associated with increased midterm mortality, warranting early transplantation in the modern BTT era.Copyright © 2016. Published by Elsevier Inc.

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