Outcomes Among Patients Bridged to Heart Transplant with Microaxial Flow Versus Durable Left Ventricular Assist Device Support.

Objective: To evaluate characteristics and outcomes of patients bridged to OHT with microaxial (ma-LVAD) versus durable (d-LVAD) left ventricular assist devices.

Methods: This was a single-center retrospective cohort study in which characteristics outcomes of patients undergoing OHT between May 2019 and May 2024 who were bridged with ma-LVAD versus d-LVAD, were compared.

Results: Over the study period, the percentage of patients bridged with ma-LVAD increased from 0% to 20%. Patients bridged with d-LVAD were more likely to have history of hypertension (80% vs 65%; p=0.03), a higher BMI (32.53 kg/m2 vs 28.15 kg/m2; p=<0.0001), and anti-HLA antibodies (54% vs 36%; p=0.02) prior to transplant, otherwise groups were similar in their baseline characteristics. Unadjusted Kaplan-Meier analysis demonstrated no difference in survival between these two bridging strategies. However, postoperative blood product usage (3 units vs 0 units, p<0.0001), moderate or severe primary graft dysfunction (27% vs 14%; p=0.04), and delayed sternal closure (45% vs 9%, p=<0.0001) were all higher among those bridged with d-LVAD versus ma-LVAD. Rejection on the first postoperative biopsy was reported in a 60% in the d-LVAD group versus 33% in the ma-LVAD group (p=0.0006). Postoperative intensive care unit (7 days vs 6 days, p=0.03) and overall postoperative length of stay (17 days vs 12 days, p=0.002) were greater in patients bridged with d-LVAD versus ma-LVAD, respectively.

Conclusion: The use of ma-LVAD compared to d-LVAD as a bridging strategy was not associated with differences in survival. However, bridging with ma-LVAD compared to d-LVAD was associated with lower post-OHT morbidity.