Low rates of inotropic support and durable left ventricular assist device placement among status 2 heart transplant candidates with temporary mechanical circulatory support.

BACKGROUND

After the 2018 heart allocation policy change, status 2 listings with temporary mechanical circulatory support (tMCS) have increased while listings with durable left ventricular assist devices (LVADs) have decreased. Treatment of cardiogenic shock varies geographically, but how often patients with status 2 are supported by inotropes before tMCS and receive durable LVADs is unknown.

METHODS

Using the Scientific Registry of Transplant Recipients, we identified all adult heart transplant candidates who received an intra-aortic balloon pump (IABP) or percutaneous endovascular ventricular assist device (PEVAD) between October 18, 2018 and December 31, 2023 and subsequently obtained status 2. We assessed the rate of overall utilization and between-center variation in use of a priori inotropic support meeting status 3 criteria and durable LVAD implantation within 6 weeks after receiving status 2.

RESULTS

During the study period, 6,010 patients with tMCS obtained status 2 (PEVADs: n = 1,957; IABPs: n = 4,053). Transplant centers reported use of inotropes meeting status 3 criteria in 7.2% of patients before IABP or PEVAD placement. The cumulative incidence of durable LVAD implantation within 6 weeks after obtaining status 2 was 2.7% (95% confidence interval [2.6%, 2.9%]). Reported rates of inotropic support before tMCS and durable LVAD implantation varied significantly by US transplant center (0%-38.8%, p < 0.001% and 0%-33.3%, p < 0.001, respectively).

CONCLUSIONS

US heart transplant centers rarely report supporting candidates with inotropes meeting status 3 criteria before initiating tMCS and do not routinely transition patients with status 2 for tMCS to durable LVAD support.