Microaxial Left Ventricular Assist Device versus Intraaortic Balloon Pump as a Bridge to Transplant.

Abstract Background Heart transplantation (HTx) candidates supported by Impella (Abiomed, Danvers, MA) or intraaortic balloon pump (IABP), who demonstrate evidence of cardiogenic shock, may qualify for waitlist Status 2 without exception under the new donor heart allocation system. However, limited data comparing Impella versus IABP as a bridge to HTx exist. Methods The United Network for Organ Sharing database was queried for adults listed and/or transplanted between 1/2014 and 2/2020. Temporal trends regarding Impella and IABP use were analyzed using the Royston trend test and chi-square test. Waitlist mortality was examined using Fine-Gray competing risks analysis. Post-HTx 180-day survival was analyzed using the Kaplan-Meier method and Cox proportional hazards models. Results Impella use increased from 0.2% in 2014 to 2.6% in 2020 (p Conclusions Post-HTx survival is comparable between Impella-supported and IABP-supported recipients despite worse preoperative profiles among Impella-supported recipients. Higher risk of waitlist delisting among Impella-supported candidates under the new allocation system requires close attention.