Heart failure (HF) continues to pose a major challenge in public health, where heart transplantation (HT) stands as the definitive treatment for advanced end-stage cases. With the rising adoption of mechanical circulatory support—chiefly left ventricular assist devices (LVADs)—as a bridge to transplant (BTT), clinicians now face more intricate patient situations. The present analysis sought to evaluate extended clinical results among individuals with heart failure with reduced ejection fraction (HFrEF) who received LVAD support as BTT, in contrast to those proceeding straight to transplant (DTT) without any device assistance, with particular attention to survival rates and complications arising after transplantation. This retrospective review, conducted at a single institution, examined 105 patients who received HT from 2010 onward. Participants were allocated into two cohorts: the BTT group (n = 28) and the DTT group (n = 77). The main outcomes measured were overall survival at 1 year and 7 years following HT. Additional endpoints focused on delayed complications, such as organ rejection episodes, renal failure, cardiac allograft vasculopathy (CAV), and cerebrovascular incidents.
During the transplant procedure, patients in the BTT arm experienced prolonged cardiopulmonary bypass and aortic cross-clamp durations due to prior LVAD placement; nonetheless, this added technical difficulty did not alter 30-day mortality rates. One-year survival reached 89.3% in the BTT cohort and 85.7% in the DTT cohort (P = 0.745). At the 7-year mark, survival was 80.8% versus 77.1% (P = 0.840). No statistically meaningful disparities appeared in the occurrence of serious late complications, including the need for permanent dialysis, episodes of organ rejection, or development of CAV. However, cerebrovascular events occurred more frequently in the BTT group (10.7% compared with 2.6%). Utilizing an LVAD as BTT does not impair short-term survival after heart transplantation when compared with direct transplantation. Over the longer term, patient outcomes showed no substantial differences between the groups, thereby confirming that LVADs represent a reliable strategy for bridging suitable candidates to successful transplantation.
