Background
Intra-aortic balloon pump (IABP) utilization has significantly outpaced other Status
2 eligibility criteria for heart transplant. The risk of waitlist mortality of IABP-supported
patients relative to other Status 2 listed patients has not been described.
Methods
We performed a retrospective analysis of all adult patients listed Status 2 for heart
transplantation under the current U.S. allocation policy, using data from the United
Network for Organ Sharing. Patients listed status 1 and status 3 for high-dose inotropes
were included for reference. Mortality and waitlist decompensation were modeled as
a function of time-varying status in cause-specific Cox survival models.
Results
We identified 3638 Status 2 listings, of whom 1676 (46%) were Status 2 due to IABP.
Relative to patients supported with IABP, status 2 patients with ventricular tachycardia/fibrillation
[VT/VF] (HR 4.0, p < .001), right-or-biventricular assist device configurations (HR 2.3, p = .002), or temporary surgical left ventricular assist devices [LVAD] (HR 2.6, p = .003) had greater risk of waitlist mortality and decompensation. Other Status 2
subgroups had mortality comparable to IABP Status 2. Risk of waitlist mortality and
decompensation for IABP Status 2 was similar to Status 3 patients listed for high-dose
inotropes (HR 1.2, p = .27) and lower than Status 1 patients (HR 0.7, p = .002).
Conclusions
Waitlist mortality varies significantly by Status 2 eligibility criteria and is highest
among patients listed for VT/VF, right-or-biVAD configurations, or temporary surgical
LVADs. IABP-supported patients were among those with the lowest Status 2 waitlist
mortality risk and comparable to Status 3 inotrope-supported patients.
Keywords
Acronyms:
BiVAD (biventricular assist device), BMI (body mass index), CI (cardiac index), HR (hazard ratio), IABP (intra-aortic balloon pump), IQR (interquartile range), LVAD (left ventricular assist device), PCWP (pulmonary capillary wedge pressure), RVAD (right ventricular assist device), SBP (systolic blood pressure), STROBE (Strengthening the Reporting of Observational Studies in Epidemiology), TAH (total artificial heart), tMCS (temporary mechanical circulatory support), UNOS (United Network for Organ Sharing), U.S. (United States), VT/VF (ventricular tachycardia and ventricular fibrillation.)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 17, 2022
Identification
Copyright
© 2022 International Society for Heart and Lung Transplantation. All rights reserved.
