Cardiovascular engineering and technology · 2026
Biventricular Assist Devices Versus Total Artificial Heart as Bridge-to-Transplantation Strategies: A Systematic Review and Meta-analysis.
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Ahmed Obay J I, Ahmed Moaz J I, Aboutabl Moustafa Mahmoud, Mohammed Mariam, Elserougi Mohamed, Mohamed Khaled Ashraf, Ghazy Tamer, Saeed Diyar, Abdelsamad Ahmed
Аннотация
PURPOSE: Biventricular assist devices (BiVADs) and total artificial heart (TAH) are the principal bridge-to-transplantation strategies for patients with advanced biventricular heart failure awaiting heart transplantation, but their comparative effectiveness and safety remain uncertain. This systematic review and meta-analysis compared pretransplant outcomes between the two approaches.
METHODS: A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, Web of Science, and Cochrane Library were searched from inception through January 2026 for studies comparing BiVADs and TAH as bridge-to-transplantation strategies. Study quality was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using the GRADE framework. Random-effects models were used to compare survival to transplantation, mortality during support, support-related complications, and duration of support.
RESULTS: Ten retrospective studies involving 2,242 patients met the inclusion criteria. The overall analysis showed no significant difference in survival to transplantation between patients supported with BiVADs and TAH (RR = 0.97, 95% CI (0.84, 1.13), P = 0.74). However, after excluding potentially overlapping cohorts, sensitivity analysis showed a higher rate of survival to transplantation in those supported with TAH (RR = 0.88, 95% CI (0.80, 0.97), P = 0.01). No significant difference was observed in mortality during support in the overall analysis (RR = 1.19, 95% CI (0.88, 1.61), P = 0.26) or after excluding potentially overlapping cohorts (RR = 0.98, 95% CI (0.79, 1.21), P = 0.84). BiVADs were associated with higher rates of bleeding and stroke (RR = 2.79, 95% CI (1.70, 4.59), P < 0.0001 and RR = 2.31, 95% CI (1.53, 3.50), P < 0.0001, respectively), whereas infection did not differ significantly between the two groups (RR = 1.18, 95% CI (0.50, 2.78), P = 0.70). Sensitivity analysis for stroke after excluding potentially overlapping cohorts showed a similarly higher rate in patients supported with BiVADs (RR = 2.39, 95% CI (1.46, 3.93), P = 0.0006). Duration of support did not differ significantly between both groups in the overall analysis (MD = 2.25 days, 95% CI (- 16.46, 20.96), P = 0.81) or after excluding potentially overlapping cohorts (MD = - 0.90 days, 95% CI (- 24.26, 22.46), P = 0.94).
CONCLUSION: TAH may be associated with higher rates of survival to transplantation after excluding potentially overlapping cohorts, while BiVAD support may be associated with higher rates of bleeding and stroke. However, all included studies were retrospective, and the certainty of evidence was low for most outcomes. These findings should therefore be interpreted with caution and require confirmation in prospective multicenter studies.
METHODS: A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, Web of Science, and Cochrane Library were searched from inception through January 2026 for studies comparing BiVADs and TAH as bridge-to-transplantation strategies. Study quality was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using the GRADE framework. Random-effects models were used to compare survival to transplantation, mortality during support, support-related complications, and duration of support.
RESULTS: Ten retrospective studies involving 2,242 patients met the inclusion criteria. The overall analysis showed no significant difference in survival to transplantation between patients supported with BiVADs and TAH (RR = 0.97, 95% CI (0.84, 1.13), P = 0.74). However, after excluding potentially overlapping cohorts, sensitivity analysis showed a higher rate of survival to transplantation in those supported with TAH (RR = 0.88, 95% CI (0.80, 0.97), P = 0.01). No significant difference was observed in mortality during support in the overall analysis (RR = 1.19, 95% CI (0.88, 1.61), P = 0.26) or after excluding potentially overlapping cohorts (RR = 0.98, 95% CI (0.79, 1.21), P = 0.84). BiVADs were associated with higher rates of bleeding and stroke (RR = 2.79, 95% CI (1.70, 4.59), P < 0.0001 and RR = 2.31, 95% CI (1.53, 3.50), P < 0.0001, respectively), whereas infection did not differ significantly between the two groups (RR = 1.18, 95% CI (0.50, 2.78), P = 0.70). Sensitivity analysis for stroke after excluding potentially overlapping cohorts showed a similarly higher rate in patients supported with BiVADs (RR = 2.39, 95% CI (1.46, 3.93), P = 0.0006). Duration of support did not differ significantly between both groups in the overall analysis (MD = 2.25 days, 95% CI (- 16.46, 20.96), P = 0.81) or after excluding potentially overlapping cohorts (MD = - 0.90 days, 95% CI (- 24.26, 22.46), P = 0.94).
CONCLUSION: TAH may be associated with higher rates of survival to transplantation after excluding potentially overlapping cohorts, while BiVAD support may be associated with higher rates of bleeding and stroke. However, all included studies were retrospective, and the certainty of evidence was low for most outcomes. These findings should therefore be interpreted with caution and require confirmation in prospective multicenter studies.