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. 2021 Mar;10(2):209-220.
doi: 10.21037/acs-2020-cfmcs-fs-197.

Continuous-flow left ventricular assist device versus orthotopic heart transplantation in adults with heart failure: a systematic review and meta-analysis

Bufan Zhang  1 , Shaohua Guo  2 , Jie Ning  3 , Yiai Li  4 , Zhigang Liu  1   4
Affiliations

Continuous-flow left ventricular assist device versus orthotopic heart transplantation in adults with heart failure: a systematic review and meta-analysis

Bufan Zhang et al. Ann Cardiothorac Surg. 2021 Mar.

Abstract

Background: Due to the lack of donor hearts, many studies have assessed the prognosis of heart failure (HF) patients treated with a continuous-flow left ventricular assist device (CF-LVAD). However, previous results have not been consistent and minimal data is available regarding long-term outcomes. There is no consensus on whether CF-LVAD as a bridge or destination therapy (DT) can equal orthotopic heart transplantation (HTx). The purpose of our study is to compare clinical outcomes between CF-LVAD and HTx in adults.

Methods: We searched controlled trials from PubMed, Cochrane Library, and Embase databases until July 1, 2020. The mortality at different time points and adverse events were analyzed among 12 included studies.

Results: No significant differences were found in mortality at one-year [odds ratio (OR) =1.08; 95% CI: 0.97-1.21], two-year (OR =1.01; 95% CI: 0.91-1.12), three-year (OR =1.02; 95% CI: 0.69-1.51), and five-year (OR =1.02; 95% CI: 0.93-1.11), as well as the comparison of stroke, bleeding, and infection between CF-LVAD as a bridge versus HTx. The pooled analysis of one-year mortality (OR =2.76; 95% CI: 0.38-20.18) and two-year mortality (OR =1.64; 95% CI: 0.22-12.23) revealed no significant difference between CF-LVAD DT and HTx. Comparisons of adverse events showed no differences in bleeding or infection, but a higher risk of stroke (OR =5.09; 95% CI: 1.74-14.84) for patients treated with CF-LVAD DT than with HTx.

Conclusions: CF-LVAD as a bridge results in similar outcomes as HTx within five years. CF-LVAD as a DT is associated with similar one-year and two-year mortality, but carries a higher risk of stroke, as compared with HTx.

Keywords: Heart failure (HF); bridge to transplantation (BTT); continuous-flow left ventricular assist device (CF-LVAD); destination therapy (DT); heart transplantation (HTx).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of the study selection process.
Figure 2
Figure 2
Forest plots for the mortality between CF-LVAD BTT vs. HTx. (A) One-year mortality, (B) two-year mortality, (C) three-year mortality, and (D) five-year mortality. CF-LVAD, continuous-flow left ventricular assist device; BTT, bridge to transplantation; HTx, heart transplantation; OR, odds ratio; CI, confidence interval.
Figure 3
Figure 3
Forest plots for the adverse events between CF-LVAD BTT vs. HTx. (A) Stroke, (B) bleeding, and (C) infection. CF-LVAD, continuous-flow left ventricular assist device; BTT, bridge to transplantation; HTx, heart transplantation; OR, odds ratio; CI, confidence interval.
Figure 4
Figure 4
Forest plots for the mortality between CF-LVAD DT vs. HTx. (A) One-year mortality and (B) two-year mortality. CF-LVAD, continuous-flow left ventricular assist device; DT, destination therapy; HTx, heart transplantation; OR, odds ratio; CI, confidence interval.
Figure 5
Figure 5
Forest plots for the adverse events between CF-LVAD DT vs. HTx. (A) Stroke, (B) bleeding, and (C) infection. CF-LVAD, continuous-flow left ventricular assist device; DT, destination therapy; HTx, heart transplantation; OR, odds ratio; CI, confidence interval.
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