Comparative analysis of outcomes: heart transplantation vs. left ventricular assist device therapy

Abstract Background Heart transplantation (HTx) and left ventricular assist device (LVAD) implantation are primary therapies for advanced heart failure (ADHF). HTx is a gold standard but therapy with LVAD has a good clinical course and favorable prognosis, especially since the implementation of a new generation device - HeartMate3. Aim The aim of the study was to compare HTx and LVAD therapy in relation to clinical characteristic and in-hospital and medium-term outcomes over the 6-month postprocedural period. Methods Single center retrospective data of continuous patients who underwent HTx or LVAD implantation from the period between February 25, 2021, and March 03, 2024 were analyzed. Results The study included 140 HTx patients and 50 LVAD patients, with a median age of 54 years (46-62). Among HTx patients, 110 (79%) were male, while the LVAD group had a notably higher proportion of males at 47 (96%); p0.001. There were no significant differences in age, heart failure etiology, or comorbidities. Pre-procedural assessments showed HTx patients had lower body mass index (BMI) (26 kg/m² ± 4 vs. 29 kg/m² ± 4, p0.001), lower mean pulmonary arterial pressure (MPAP) (30 ± 10 mmHg vs. 42 ± 12 mmHg, p0.001) compared to LVAD patients. The HTx group had a longer ICU stay (7 6-12 vs. 5 3-7 days, p0.001) and more frequent infectious complications during hospital stay (37% vs. 8%, p0.001). During the 6-month post-procedure period, 27 patients (14%) died, with no significant difference between HTx (20 patients, 14%) and LVAD (7 patients, 14%), p=0.82. The picture 1 presents Kaplan-Meier Curves for mortality in Htx and LVAD patients. Conclusion The differences in clinical characteristics of both groups are due to the qualification criteria. HTx patients experienced longer ICU stays and a higher incidence of infectious complications in the early period after hospitalization. Nevertheless, over a 6-month observation period, there were no major differences in all-cause mortality between HTx and LVAD implantation for ADHF.Picture 1