Meta-analysis of durable compared to temporary left ventricular assist devices compared to venoarterial extracorporeal membrane oxygenation for bridging to heart transplantation or treatment of primary graft dysfunction

Abstract

Background:

Patients bridged to heart transplantation (HTx) and patients with primary graft dysfunction (PGD) after HTx are typically treated with circulatory support. However, the survival of patients in both indications might depend on the type of circulatory support. Thus, this meta-analysis aimed to investigate the survival of HTx patients supported during bridging with a durable left ventricular assist device (d-LVAD), a temporary LVAD (t-LVAD), or venoarterial extracorporeal membrane oxygenation (VA-ECMO). We also investigated the survival rate of patients with PGD by type of circulatory support device. Methods:

We performed a random-effects meta-analysis. Results:

We included four studies evaluating bridging to HTx (n = 1678 patients) and three studies for the PGD analysis (n = 35 patients). The 1-year survival after HTx was significantly higher in patients bridged with a t-LVAD (92.7%; 95% confidence interval (CI): 89.2 to 95.6%; p = 0.027) and with a d-LVAD (86.8%; 95% CI: 75.8 to 94.8%; p = 0.001) compared to VA-ECMO (71.6%; 95% CI: 63.7 to 78.9%). The 30-day survival in patients with PGD and t-LVAD was 100% (95% CI: 59.2–100%), while with PGD and VA-ECMO, survival was 92.4% (95% CI: 66 to 100%). Conclusions:

Both d-LVAD and t-LVAD bridging methods appear to have comparable 1-year survival rates, which are higher than those after VA-ECMO bridging. Nonetheless, more prospective clinical studies are needed to investigate outcomes after using circulatory support devices for PGD after HTx.