LAUSR

Purpose Many patients listed with intraaortic balloon pump (IABP) currently undergo direct heart transplantation (HTx). However, donor hearts have a finite lifespan. Thus, implantation of a durable left ventricular assist device (LVAD) could extend the patient's life by delaying HTx. We sought to evaluate whether implantation of a durable LVAD as a bridge to HTx improves total survival after waitlist initiation compared to direct bridging among candidates listed with IABP. Methods The United Network for Organ Sharing (UNOS) database was queried for adults listed for HTx with an IABP who were either directly transplanted or transitioned to a durable LVAD and then transplanted between January 2006 and September 2015. Total survival time following listing was analyzed using the Kaplan-Meier method and Cox proportional hazards analysis with adjustment for age at listing, gender, and body mass index at listing. The data we present are conditional on survival to HTx, since the UNOS database lacks granularity regarding the waitlist course of candidates who did not survive to HTx. Results 774 recipients were included in this study. 237 (30.6%) were transitioned to durable LVAD from IABP at listing. Transition to durable LVAD did not reduce hazard of post-listing mortality compared to direct bridge with IABP at 1 year (adjusted hazard ratio (aHR) 0.68, 95% CI 0.39-1.18, p=0.17), 3 years (aHR 0.78, 95% CI 0.53-1.14, p=0.20), or 5 years (aHR 0.82, 95% CI 0.59-1.15, p-0.26). However, transition to LVAD provided a protective effect at 180 days after listing (aHR 0.23, 95% CI 0.08-0.63, p Conclusion While long-term survival is comparable between groups, bridging with durable LVAD among candidates initially listed with IABP could provide a short-term protective effect if the patient can survive to HTx.