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 orthotopic heart transplantation with microaxial left ventricular assist device (ma-LVAD) versus durable LVAD (d-LVAD). METHODS: This was a single-center retrospective cohort study in which characteristics outcomes of patients undergoing orthotopic heart transplantation 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 = .03), a higher body mass index (32.53 vs 28.15; P < .0001), and anti-human leukocyte antigens antibodies (54% vs 36%; P = .02) before transplant, otherwise groups were similar in their baseline characteristics. Unadjusted Kaplan-Meier analysis demonstrated no difference in survival between these 2 bridging strategies. However, postoperative blood product use (3 vs 0 units; P < .0001), moderate or severe primary graft dysfunction (27% vs 14%; P = .04), and delayed sternal closure (45% vs 9%; P < .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 = .0006). Postoperative intensive care unit (7 vs 6 days; P = .03) and overall postoperative length of stay (17 vs 12 days; P = .002) were greater in patients bridged with d-LVAD versus ma-LVAD, respectively. CONCLUSIONS: The use of ma-LVAD compared with d-LVAD as a bridging strategy was not associated with differences in survival. However, bridging with ma-LVAD compared with d-LVAD was associated with lower morbidity after orthotopic heart transplantation.