Maximizing Survival of End-Stage Heart Failure Patients: Bridge to Continuous Left Ventricular Assist Device Before Transplant

The continuous flow left ventricular assist devices (CFVAD) were designed for bridge-to-transplant therapy (BTT). We evaluated their overall impact on end-stage heart failure survival (before and after transplant) using the United Network for Organ Sharing (UNOS) database from 2005 to 2024 for adult patients. The patients were divided into groups based on CFVAD use and age > or ≤50 years. A composite survival was calculated by the addition of waitlist duration, prelisting CFVAD duration (for CFVADs only), and post-transplant (for transplanted patients only) survival. A total of 55,468 patients were listed, 18,930 had CFVADs and 36,538 had no mechanical circulatory support (MCS). A logistic regression model identified male gender, Black race, blood group O, noncongenital cardiomyopathy, and younger age as factors associated with increased CFVAD use. In patients with a higher likelihood of CFVAD use, composite survival at 5 years was significantly better with CFVAD (93% vs. 81%). In patients <50 years, use of CFVAD showed better 5 year composite survival compared with no-MCS and patients older than 50 years (95% vs. 92%, 85%, 84% p < 0.01, F4). In conclusion, use of CFVAD for BTT, particularly in younger patients has overall composite survival advantage compared with no-MCS patients. More eligible patients should be implanted with CFVAD before transplant to maximize their overall heart failure survival.