Biventricular Assist Devices Versus Total Artificial Heart as Bridge-to-Transplantation Strategies: A Systematic Review and Meta-analysis.

IF 2.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Engineering and Technology Pub Date : 2026-10-13 DOI:10.1007/s13239-026-00864-8

Obay J I Ahmed, Moaz J I Ahmed, Moustafa Mahmoud Aboutabl, Mariam Mohammed, Mohamed Elserougi, Khaled Ashraf Mohamed, Tamer Ghazy, Diyar Saeed, Ahmed Abdelsamad

{"title":"Biventricular Assist Devices Versus Total Artificial Heart as Bridge-to-Transplantation Strategies: A Systematic Review and Meta-analysis.","authors":"Obay J I Ahmed, Moaz J I Ahmed, Moustafa Mahmoud Aboutabl, Mariam Mohammed, Mohamed Elserougi, Khaled Ashraf Mohamed, Tamer Ghazy, Diyar Saeed, Ahmed Abdelsamad","doi":"10.1007/s13239-026-00864-8","DOIUrl":null,"url":null,"abstract":"Purpose: Biventricular assist devices (BiVADs) and total artificial heart (TAH) are the principal bridge-to-transplantation strategies for patients with advanced biventricular heart failure awaiting heart transplantation, but their comparative effectiveness and safety remain uncertain. This systematic review and meta-analysis compared pretransplant outcomes between the two approaches.Methods: A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, Web of Science, and Cochrane Library were searched from inception through January 2026 for studies comparing BiVADs and TAH as bridge-to-transplantation strategies. Study quality was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using the GRADE framework. Random-effects models were used to compare survival to transplantation, mortality during support, support-related complications, and duration of support.Results: Ten retrospective studies involving 2,242 patients met the inclusion criteria. The overall analysis showed no significant difference in survival to transplantation between patients supported with BiVADs and TAH (RR = 0.97, 95% CI (0.84, 1.13), P = 0.74). However, after excluding potentially overlapping cohorts, sensitivity analysis showed a higher rate of survival to transplantation in those supported with TAH (RR = 0.88, 95% CI (0.80, 0.97), P = 0.01). No significant difference was observed in mortality during support in the overall analysis (RR = 1.19, 95% CI (0.88, 1.61), P = 0.26) or after excluding potentially overlapping cohorts (RR = 0.98, 95% CI (0.79, 1.21), P = 0.84). BiVADs were associated with higher rates of bleeding and stroke (RR = 2.79, 95% CI (1.70, 4.59), P < 0.0001 and RR = 2.31, 95% CI (1.53, 3.50), P < 0.0001, respectively), whereas infection did not differ significantly between the two groups (RR = 1.18, 95% CI (0.50, 2.78), P = 0.70). Sensitivity analysis for stroke after excluding potentially overlapping cohorts showed a similarly higher rate in patients supported with BiVADs (RR = 2.39, 95% CI (1.46, 3.93), P = 0.0006). Duration of support did not differ significantly between both groups in the overall analysis (MD = 2.25 days, 95% CI (- 16.46, 20.96), P = 0.81) or after excluding potentially overlapping cohorts (MD = - 0.90 days, 95% CI (- 24.26, 22.46), P = 0.94).Conclusion: TAH may be associated with higher rates of survival to transplantation after excluding potentially overlapping cohorts, while BiVAD support may be associated with higher rates of bleeding and stroke. However, all included studies were retrospective, and the certainty of evidence was low for most outcomes. These findings should therefore be interpreted with caution and require confirmation in prospective multicenter studies.","PeriodicalId":54322,"journal":{"name":"Cardiovascular Engineering and Technology","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular Engineering and Technology","FirstCategoryId":"5","ListUrlMain":"https://doi.org/10.1007/s13239-026-00864-8","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: Biventricular assist devices (BiVADs) and total artificial heart (TAH) are the principal bridge-to-transplantation strategies for patients with advanced biventricular heart failure awaiting heart transplantation, but their comparative effectiveness and safety remain uncertain. This systematic review and meta-analysis compared pretransplant outcomes between the two approaches.

Methods: A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, Web of Science, and Cochrane Library were searched from inception through January 2026 for studies comparing BiVADs and TAH as bridge-to-transplantation strategies. Study quality was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using the GRADE framework. Random-effects models were used to compare survival to transplantation, mortality during support, support-related complications, and duration of support.

Results: Ten retrospective studies involving 2,242 patients met the inclusion criteria. The overall analysis showed no significant difference in survival to transplantation between patients supported with BiVADs and TAH (RR = 0.97, 95% CI (0.84, 1.13), P = 0.74). However, after excluding potentially overlapping cohorts, sensitivity analysis showed a higher rate of survival to transplantation in those supported with TAH (RR = 0.88, 95% CI (0.80, 0.97), P = 0.01). No significant difference was observed in mortality during support in the overall analysis (RR = 1.19, 95% CI (0.88, 1.61), P = 0.26) or after excluding potentially overlapping cohorts (RR = 0.98, 95% CI (0.79, 1.21), P = 0.84). BiVADs were associated with higher rates of bleeding and stroke (RR = 2.79, 95% CI (1.70, 4.59), P < 0.0001 and RR = 2.31, 95% CI (1.53, 3.50), P < 0.0001, respectively), whereas infection did not differ significantly between the two groups (RR = 1.18, 95% CI (0.50, 2.78), P = 0.70). Sensitivity analysis for stroke after excluding potentially overlapping cohorts showed a similarly higher rate in patients supported with BiVADs (RR = 2.39, 95% CI (1.46, 3.93), P = 0.0006). Duration of support did not differ significantly between both groups in the overall analysis (MD = 2.25 days, 95% CI (- 16.46, 20.96), P = 0.81) or after excluding potentially overlapping cohorts (MD = - 0.90 days, 95% CI (- 24.26, 22.46), P = 0.94).

Conclusion: TAH may be associated with higher rates of survival to transplantation after excluding potentially overlapping cohorts, while BiVAD support may be associated with higher rates of bleeding and stroke. However, all included studies were retrospective, and the certainty of evidence was low for most outcomes. These findings should therefore be interpreted with caution and require confirmation in prospective multicenter studies.

查看原文本刊更多论文

双心室辅助装置与全人工心脏作为移植的桥梁策略：系统回顾和荟萃分析。

目的：双室辅助装置（BiVADs）和全人工心脏（TAH）是等待心脏移植的晚期双室心力衰竭患者的主要桥接移植策略，但其相对有效性和安全性仍不确定。本系统综述和荟萃分析比较了两种方法的移植前结果。方法：根据系统评价和meta分析指南的首选报告项目进行系统评价和meta分析。PubMed、Scopus、Web of Science和Cochrane Library从成立到2026年1月检索了BiVADs和TAH作为移植桥策略的比较研究。使用纽卡斯尔-渥太华量表评估研究质量，使用GRADE框架评估证据的确定性。随机效应模型用于比较移植的存活率、支持期间的死亡率、支持相关并发症和支持持续时间。结果：10项回顾性研究包括2242例患者符合纳入标准。总体分析显示BiVADs和TAH支持患者的移植生存率无显著差异（RR = 0.97, 95% CI (0.84, 1.13), P = 0.74）。然而，在排除可能重叠的队列后，敏感性分析显示，TAH支持患者的移植存活率更高（RR = 0.88, 95% CI (0.80, 0.97), P = 0.01）。在整体分析中，支持期间的死亡率没有观察到显著差异（RR = 1.19, 95% CI (0.88, 1.61), P = 0.26）或排除潜在重叠队列后（RR = 0.98, 95% CI (0.79, 1.21), P = 0.84）。BiVAD与较高的出血和卒中发生率相关(RR = 2.79, 95% CI (1.70, 4.59)， P结论：排除潜在重叠队列后，TAH可能与较高的移植存活率相关，而BiVAD支持可能与较高的出血和卒中发生率相关。然而，所有纳入的研究都是回顾性的，大多数结果的证据确定性较低。因此，这些发现应谨慎解释，并需要在前瞻性多中心研究中得到证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Cardiovascular Engineering and Technology Engineering-Biomedical Engineering

CiteScore

4.00

自引率

0.00%

发文量

期刊介绍： Cardiovascular Engineering and Technology is a journal publishing the spectrum of basic to translational research in all aspects of cardiovascular physiology and medical treatment. It is the forum for academic and industrial investigators to disseminate research that utilizes engineering principles and methods to advance fundamental knowledge and technological solutions related to the cardiovascular system. Manuscripts spanning from subcellular to systems level topics are invited, including but not limited to implantable medical devices, hemodynamics and tissue biomechanics, functional imaging, surgical devices, electrophysiology, tissue engineering and regenerative medicine, diagnostic instruments, transport and delivery of biologics, and sensors. In addition to manuscripts describing the original publication of research, manuscripts reviewing developments in these topics or their state-of-art are also invited.