Differences in wait-list mortality: Temporary vs durable circulatory support devices
Background: In 2018, changes in the United Network for Organ Sharing (UNOS) allocation system led to a shift in practices, making durable left ventricular assist devices less desirable as a bridge to transplantation compared to temporary mechanical circulatory support. This study compares the compos...
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Elsevier
2025-08-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425001077 |
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| author | Mahwash Kassi, MD Salma Zook, MD Duc Nguyen, MD, PhD Katelyn Ingram, BS Sapna Legha, MD Rayan Yousefzai, MD Ju Kim, MD Imad Hussain, MD Cindy M. Martin, MD Janardhana Gorthi, MD Adeel Ahsan Syed, MD Nadia Fida, MD Arvind Bhimaraj, MD Edward A. Graviss, PhD Ashrith Guha, MD |
| author_facet | Mahwash Kassi, MD Salma Zook, MD Duc Nguyen, MD, PhD Katelyn Ingram, BS Sapna Legha, MD Rayan Yousefzai, MD Ju Kim, MD Imad Hussain, MD Cindy M. Martin, MD Janardhana Gorthi, MD Adeel Ahsan Syed, MD Nadia Fida, MD Arvind Bhimaraj, MD Edward A. Graviss, PhD Ashrith Guha, MD |
| author_sort | Mahwash Kassi, MD |
| collection | DOAJ |
| description | Background: In 2018, changes in the United Network for Organ Sharing (UNOS) allocation system led to a shift in practices, making durable left ventricular assist devices less desirable as a bridge to transplantation compared to temporary mechanical circulatory support. This study compares the composite outcome of waitlist mortality and delisting incidence at 1 year between these two support types. Methods: All actively listed adult patients on mechanical circulatory support listed for heart transplantation under the current UNOS system from October 2018 to October 2021 were included, excluding those with right ventricular devices, biventricular devices, total artificial hearts, and extracorporeal membrane oxygenators. The primary outcome was the composite of waitlist mortality and delisting due to clinical deterioration at 1 year. Survival analysis was conducted using Kaplan-Meier curves and multivariable Cox regression. Results: A total of 4,569 patients were included, with 1,877 on temporary mechanical circulatory support and 2,692 on left ventricular assist devices. Propensity-score matching was performed on 660 patients divided into two groups. The event rate was lower in the left ventricular assist device group compared to the temporary mechanical circulatory support group (15.9% vs 35.2%, p < 0.001). Temporary mechanical circulatory support had a significantly higher multivariable hazard ratio (HR) for outcome events (HR 3.37, p < 0.001). The HeartMate 3 (HM3) had the best outcomes compared to all other device types. Conclusion: In this propensity-score-matched analysis, durable mechanical circulatory support had better outcomes than temporary mechanical circulatory support. HM3 had the lowest risk of composite outcomes. |
| format | Article |
| id | doaj-art-4060c0740f4d438aa9ababa3f1dfa7a3 |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-4060c0740f4d438aa9ababa3f1dfa7a32025-08-20T03:41:57ZengElsevierJHLT Open2950-13342025-08-01910031210.1016/j.jhlto.2025.100312Differences in wait-list mortality: Temporary vs durable circulatory support devicesMahwash Kassi, MD0Salma Zook, MD1Duc Nguyen, MD, PhD2Katelyn Ingram, BS3Sapna Legha, MD4Rayan Yousefzai, MD5Ju Kim, MD6Imad Hussain, MD7Cindy M. Martin, MD8Janardhana Gorthi, MD9Adeel Ahsan Syed, MD10Nadia Fida, MD11Arvind Bhimaraj, MD12Edward A. Graviss, PhD13Ashrith Guha, MD14Department of Cardiology, Houston Methodist Hospital – DeBakey Heart and Vascular Center, Houston, TX; Corresponding author: Mahwash Kassi, MD, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030.Department of Cardiology, Houston Methodist Hospital – DeBakey Heart and Vascular Center, Houston, TXDepartment of Pediatrics, Baylor College of Medicine, Houston, TXDepartment of Cardiology, Houston Methodist Hospital – DeBakey Heart and Vascular Center, Houston, TXDepartment of Cardiology, Houston Methodist Hospital – DeBakey Heart and Vascular Center, Houston, TXDepartment of Cardiology, Houston Methodist Hospital – DeBakey Heart and Vascular Center, Houston, TXDepartment of Cardiology, Houston Methodist Hospital – DeBakey Heart and Vascular Center, Houston, TXDepartment of Cardiology, Houston Methodist Hospital – DeBakey Heart and Vascular Center, Houston, TXDepartment of Cardiology, Houston Methodist Hospital – DeBakey Heart and Vascular Center, Houston, TXDepartment of Cardiology, Houston Methodist Hospital – DeBakey Heart and Vascular Center, Houston, TXDepartment of Cardiology, Houston Methodist Hospital – DeBakey Heart and Vascular Center, Houston, TXDepartment of Cardiology, Houston Methodist Hospital – DeBakey Heart and Vascular Center, Houston, TXDepartment of Cardiology, Houston Methodist Hospital – DeBakey Heart and Vascular Center, Houston, TXDepartment of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX; Department of Surgery, Houston Methodist Hospital, Houston, TXDepartment of Cardiology, Houston Methodist Hospital – DeBakey Heart and Vascular Center, Houston, TXBackground: In 2018, changes in the United Network for Organ Sharing (UNOS) allocation system led to a shift in practices, making durable left ventricular assist devices less desirable as a bridge to transplantation compared to temporary mechanical circulatory support. This study compares the composite outcome of waitlist mortality and delisting incidence at 1 year between these two support types. Methods: All actively listed adult patients on mechanical circulatory support listed for heart transplantation under the current UNOS system from October 2018 to October 2021 were included, excluding those with right ventricular devices, biventricular devices, total artificial hearts, and extracorporeal membrane oxygenators. The primary outcome was the composite of waitlist mortality and delisting due to clinical deterioration at 1 year. Survival analysis was conducted using Kaplan-Meier curves and multivariable Cox regression. Results: A total of 4,569 patients were included, with 1,877 on temporary mechanical circulatory support and 2,692 on left ventricular assist devices. Propensity-score matching was performed on 660 patients divided into two groups. The event rate was lower in the left ventricular assist device group compared to the temporary mechanical circulatory support group (15.9% vs 35.2%, p < 0.001). Temporary mechanical circulatory support had a significantly higher multivariable hazard ratio (HR) for outcome events (HR 3.37, p < 0.001). The HeartMate 3 (HM3) had the best outcomes compared to all other device types. Conclusion: In this propensity-score-matched analysis, durable mechanical circulatory support had better outcomes than temporary mechanical circulatory support. HM3 had the lowest risk of composite outcomes.http://www.sciencedirect.com/science/article/pii/S2950133425001077Heart transplantationMechanical circulatory supportUNOS allocation systemWaitlist mortalityPropensity score-matching |
| spellingShingle | Mahwash Kassi, MD Salma Zook, MD Duc Nguyen, MD, PhD Katelyn Ingram, BS Sapna Legha, MD Rayan Yousefzai, MD Ju Kim, MD Imad Hussain, MD Cindy M. Martin, MD Janardhana Gorthi, MD Adeel Ahsan Syed, MD Nadia Fida, MD Arvind Bhimaraj, MD Edward A. Graviss, PhD Ashrith Guha, MD Differences in wait-list mortality: Temporary vs durable circulatory support devices JHLT Open Heart transplantation Mechanical circulatory support UNOS allocation system Waitlist mortality Propensity score-matching |
| title | Differences in wait-list mortality: Temporary vs durable circulatory support devices |
| title_full | Differences in wait-list mortality: Temporary vs durable circulatory support devices |
| title_fullStr | Differences in wait-list mortality: Temporary vs durable circulatory support devices |
| title_full_unstemmed | Differences in wait-list mortality: Temporary vs durable circulatory support devices |
| title_short | Differences in wait-list mortality: Temporary vs durable circulatory support devices |
| title_sort | differences in wait list mortality temporary vs durable circulatory support devices |
| topic | Heart transplantation Mechanical circulatory support UNOS allocation system Waitlist mortality Propensity score-matching |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425001077 |
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