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

Heart waitlist survival in adults with an intra-aortic balloon pump relative to other Status 2, Status 1, and inotrope Status 3 patients

Published:October 17, 2022DOI:https://doi.org/10.1016/j.healun.2022.10.010

      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.)
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