Do posttransplant outcomes differ in heart transplant recipients bridged with continuous and pulsatile flow left ventricular assist devices?

Background: The purpose of this study was to compare posttransplantation morbidity and mortality in orthotopic heart transplant recipients bridged to transplant with (1) continuous-flow left ventricular assist device (LVAD), (2) pulsatile-flow LVAD, or (3) inotropic therapy only with no LVAD. Methods: The United Network for Organ Sharing provided deidentified patient-level data. All status 1 orthotopic heart transplant recipients (n = 7,744) 18 or more years of age and transplanted between January 1, 2001, and December 31, 2008, were included. Follow-up was available through June 18, 2009. Recipients were stratified into three groups: inotropes (n = 5,448, 70.4%), continuous-flow LVAD (CONT [n = 564, 7.3%]), and pulsatile-flow LVAD (PULS [n = 1,732, 22.4%]). The primary outcome measure was risk-adjusted posttransplant graft survival (PTGS) at 90 days. Secondary outcomes included risk-adjusted PTGS at 90 days to 1 year and 1 to 5 years. Results: Unadjusted PTGS was similar in all groups (p = 0.920). When compared with recipients bridged with inotropes, PTGS for patients bridged with an LVAD (CONT or PULS) did not differ in any follow-up period analyzed (<90 days, 90 days to 1 year, and 1 to 5 years). The PTGS in the CONT group (p = 0.021), but not in the PULS group (p = 0.244), improved significantly between the first half of the study period (2001 to 2004) and the second half (2005 to 2008). Conclusions: Compared with recipients bridged with inotropes, neither unadjusted nor adjusted PTGS differed for either the CONT group or the PULS group. Outcomes among the CONT group improved significantly from the first to the second half of the study period.