• Taylor Nordan, Mohamed Keshk, Amy Hackmann, Michael M Givertz, Mandeep R Mehra, Mark J Cunningham, and Akinobu Itoh.
• Division of Cardiac Surgery.
• J. Thorac. Cardiovasc. Surg. 2024 Sep 25.

ObjectiveWaitlist time for UNOS Status 2 heart transplantation (HTx) candidates has steadily increased. We compared a bridging strategy using either Impella 5.0/5.5 ("Impella") or intra-aortic balloon pump (IABP) to durable LVAD in blood type O patients, stratified by body habitus.MethodsThe UNOS registry was queried for adults listed for de-novo HTx (without dialysis) supported by either Impella, IABP, or HM3 LVAD. The primary outcome was one-year post-listing survival, defined as the sum of waitlist time and post-HTx survival time if the candidate underwent HTx.ResultsIn total, 2,942 candidates were included (Impella: 214; IABP: 1326; HM3:1402). Listing with Impella or IABP was associated with worse post-listing survival compared to HM3 LVAD in type O candidates (Impella: HR 2.90 [95% CI 1.48-5.67], P=0.002; IABP: HR 2.42 [95% CI 1.59-3.68], P<0.001) but less so in non-type O candidates. Further analysis of type O candidates demonstrated that Impella and IABP were associated with lesser risk of post-listing mortality among those with normal height (25-75th percentile) and non-obese (BMI<30) (Impella: HR 1.78 [95% CI 0.61-5.18], P=0.292; IABP: HR 1.28 [95% CI 0.67-2.45], P=0.455); among those not both normal height and non-obese, Impella and IABP were associated with elevated risk of post-listing mortality (Impella: HR 3.65 [95% CI 1.68-7.95], P=0.001; IABP: HR 3.01 [95% CI 1.95-4.67], P<0.001).ConclusionsBlood type O candidates listed with Impella or IABP are at increased risk of post-listing mortality compared to durable LVAD in the current organ allocation era. These effects are diminished among those with normal height and body habitus.Copyright © 2024. Published by Elsevier Inc.

3 keywords...

hide…