Bridging Strategies and their Association with Post Heart Transplant Outcomes

Objective Heart transplant (HT) remains the definitive therapy for patients with end stage heart failure (HF). The rate of heart transplantation is limited by the availability of suitable donors, and thus waiting time varies. Bridging strategies have been implemented to stabilize hemodynamics and alleviate debilitating symptoms of HF in patients awaiting HT. In this study we performed a comparative analysis of bridging strategies and their association with post HT outcomes. Methods This was an analysis of 20,919 adult HT recipients captured in the United Network for Organ Sharing (UNOS) heart transplant registry that were bridged to transplant utilizing a bridging strategy inclusive of a left ventricular assist device (VAD), Intra-aortic balloon pump (IABP), or intravenous inotropic agents. Outcomes of interest included graft failure and patient survival. Chi square analysis was used to detect baseline differences between the three groups. Competing risk analysis was used to assess the outcomes of interest. Results In each group HT recipients were predominately Caucasian, and male with a median ischemic time of 3.2 hours (Table 1). Median patient survival was significantly highest in the Inotrope group, and lowest in the IABP group (1648 vs 828 days p= Conclusions Among bridging strategies inclusive of LVAD, IABP and intravenous intropic therapy, long term median survival was observed to be longest in those bridged with intravenous inotropes. No difference in the outcome of acute graft failure was observed. Further analysis is needed to understand the survival differences observed in this study.