The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Bridging to transplant with HeartMate 3 left ventricular assist devices in the new heart organ allocation system: An individualized approach

Published:September 09, 2022DOI:


      Following the MOMENTUM 3 trial and the discontinuation of the HeartWare HVAD, the HeartMate 3 LVAD (HM 3) has become the main durable device for bridging to transplantation; however, outcome of this strategy in the new heart allocation system is not well understood.


      The United Network for Organ Sharing (UNOS) registry was queried to include adult patients (≥18 years old) listed for heart transplantation between 2010 and 2020. Trends in durable LVAD utilization and outcomes of patients with HM 3 LVAD were examined in the pre- vs post-heart allocation system.


      From 2017 to 2020, there was a 28.3% decline in the number of patients waitlisted with an FDA-approved durable LVAD. Overall, 449 patients were waitlisted with HM 3 in the pre-allocation era compared to 1094 patients in the post-allocation. Cumulative incidence of heart transplantation (53.4% vs 50.7%, p = 0.76) and death or delisting for worsening status (5.0%, vs 4.2%, p = 0.43) at 1-year after listing with HM 3 LVAD was comparable in the pre- vs post-allocation era. Old age (>50), ischemic HF, poor functional status, elevated creatinine (>1.3 mg/dL), pulmonary hypertension (>3 WU), and obesity (body mass index > 33 kg/m2) were predictors of post-transplant graft mortality after bridging with HM 3.


      While the utilization of durable devices as BTT have declined under the new heart allocation system, bridging with HM 3 LVAD remains a safe strategy in carefully selected patients. Bridging decision should be individualized based on patient risk factors.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Heart and Lung Transplantation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mehra MR
        • Uriel N
        • Naka Y
        • et al.
        A fully magnetically levitated left ventricular assist device—final report.
        N Engl J Med. 2019; 380: 1618-1627
        • Molina EJ
        • Shah P
        • Kiernan MS
        • et al.
        The society of thoracic surgeons intermacs 2020 annual report.
        Ann Thorac Surg. 2021; 111: 778-792
        • Potapov EV
        • Nersesian G
        • Lewin D
        • et al.
        Propensity score-based analysis of long-term follow-up in patients supported with durable centrifugal left ventricular assist devices: the EUROMACS analysis.
        Eur J Cardiothorac Surg. 2021; 60: 579-587
        • Goff RR
        • Uccellini K
        • Lindblad K
        • et al.
        A change of heart: preliminary results of the US 2018 adult heart allocation revision.
        Am J Transplant. 2020; 20: 2781-2790
        • Estep JD
        • Soltesz E
        • Cogswell R.
        The new heart transplant allocation system: early observations and mechanical circulatory support considerations.
        J Thorac Cardiovasc Surg. 2022;
        • Truby LK
        • Farr M
        • Topkara VK.
        Critically appraising the 2018 United Network for Organ Sharing donor allocation policy: adding life boats or rearranging the deck chairs?.
        Curr Opin Anaesthesiol. 2022; 35: 42-47
        • Mullan CW
        • Chouairi F
        • Sen S
        • et al.
        Changes in use of left ventricular assist devices as bridge to transplantation with new heart allocation policy.
        JACC Heart Fail. 2021; 9: 420-429
        • Parker WF
        • Churpek MM
        • Anderson AS.
        Is it too early to investigate survival outcomes of the new US heart allocation system?.
        J Heart Lung Transplant. 2020; 39: 726
        • Hanff TC
        • Harhay MO
        • Kimmel SE
        • Birati EY
        • Acker MA.
        Update to an early investigation of outcomes with the new 2018 donor heart allocation system in the United States.
        J Heart Lung Transplant. 2020; 39: 725-726
        • Heagerty PJ
        • Lumley T
        • Pepe MS.
        Time-dependent ROC curves for censored survival data and a diagnostic marker.
        Biometrics. 2000; 56: 337-344
        • Cogswell R
        • John R
        • Estep JD
        • et al.
        An early investigation of outcomes with the new 2018 donor heart allocation system in the United States.
        J Heart Lung Transplant. 2020; 39: 1-4
        • Varshney AS
        • Berg DD
        • Katz JN
        • et al.
        Use of temporary mechanical circulatory support for management of cardiogenic shock before and after the united network for organ sharing donor heart allocation system changes.
        JAMA Cardiol. 2020; 5: 703-708
        • Axtell AL
        • Fiedler AG
        • Lewis G
        • et al.
        Reoperative sternotomy is associated with increased early mortality after cardiac transplantation.
        Eur J Cardiothorac. 2019; 55: 1136-1143
        • Amin AP
        • Spertus JA
        • Curtis JP
        • et al.
        The evolving landscape of Impella use in the United States among patients undergoing percutaneous coronary intervention with mechanical circulatory support.
        Circulation. 2020; 141: 273-284
        • Jain R
        • Habal MV
        • Clerkin KJ
        • et al.
        De novo human leukocyte antigen allosensitization in HeartMate 3 Versus HeartMate II left ventricular assist device recipients.
        ASAIO J. 2022; 68: 226-232
        • Lazenby KA
        • Narang N
        • Pelzer KM
        • Ran G
        • Parker WF.
        An updated estimate of posttransplant survival after implementation of the new donor heart allocation policy.
        Am J Transplant. 2022; 22: 1683-1690
        • Segovia J
        • Cosio DG
        • Barcelo JM
        • et al.
        RADIAL: a novel primary graft failure risk score in heart transplantation.
        J Heart Lung Transplant. 2011; 30: 644-651