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Under the revised heart allocation system in the United States, bridge to transplant (BTT) patients with left ventricular assist device (LVAD) have a longer waitlist period, as they are now lowly prioritized. However, little is known regarding the long-term trajectory of functional capacity (FC) and health-related quality of life (HR-QOL) among BTT-LVAD patients. We retrospectively analyzed 442 consecutive patients with BTT-LVAD between April 2013 and May 2019 from a Japanese nationwide registry. FC (New York Heart Association [NYHA] functional class, peak oxygen uptake [VO 2 ], and 6-min walk test [6MWT]) and HR-QOL (European Quality of Life [EQ-5D index] and Visual Analogue Scale [EQ-VAS]) were assessed at baseline and for up to 60 months after LVAD implantation. During the follow-up period of 30 months (IQR 18–42 months), 100 (22.6%) patients underwent transplantation, 37 (8.3%) died, and 14 (3.1%) underwent explantation for recovery. Mean peak VO 2 , 6MWT distance, EQ-5D index, and EQ-VAS significantly improved 3 months after LVAD implantation (p = 0.0012, p = 0.0037, p < 0.001, p < 0.001, respectively). Furthermore, these improvements were sustained for up to 60 months following LVAD implantation. Major adverse events including device failure, infection, stroke, and bleeding, which occurred within the first 3 months after LVAD implantation may have not affected FC or HR-QOL for up to 60 months (p = 0.15, p = 0.22, respectively). BTT patients showed long-term preservation of FC and HR-QOL, suggesting that BTT remains an option despite the long waiting time to HTx. • BTT-LVAD patients showed long-term preservation of functional capacity and HR-QOL. • Early major adverse events may have not affected long-term functional capacity or HR-QOL. • This study suggested that BTT remains an option despite the long waiting list time. [ABSTRACT FROM AUTHOR]

Background: Limited data exist describing impact of body mass index (BMI) on post‒left ventricular assist device (post-LVAD) outcomes. We sought to define the relationship between body mass index (BMI) and adverse events (AEs) after LVAD implantation by examining the ISHLT Mechanically Assisted Circulatory Support (IMACS) registry., Methods: Patients implanted with a contemporary continuous flow (CF)-LVAD were stratified into 4 groups using pre-operative BMI: underweight (UW; BMI ≤18.5 kg/m 2 ); non-obese (NO; BMI >18.5 to <30 kg/m 2 ); obese (OB; BMI ≥30 to <40 kg/m 2 ); and morbidly obese (MO; BMI ≥40 kg/m 2 ). Freedom from AEs was evaluated using the Kaplan-Meier method and risk factors for development of first AE were identified using multiphase parametric hazard modeling. AEs included infection, thromboembolic events, bleeding, device malfunction, and neurologic dysfunction., Results: Between 2013 and 2015, a total of 9,408 patients underwent implantation of a CF-LVAD, which consisted of 368 (4%) UW, 5,719 (61%) NO, 2,770 (29%) OB, and 444 (5%) MO patients. Survival among the 4 BMI cohorts was similar at 2years (70.8% to 75.8%, p = 0.24). MO patients were less likely to be free from a non‒VAD-related infection (p < 0.0001) or device-related infection (p = 0.0014) at 2years (50.3%, 70.7%) when compared with OB (58.3%, 78.7%), NO (65.2%, 81.4%), and UW (68.9%, 77.4%) patients. UW (81.5%) and NO (81.3%) patients were more likely to be free from device malfunction at 2years when compared with OB (78.3%) and MO (72.6%) (p = 0.0006). Thromboembolic events were rare and more common in the UW cohort (p = 0.026)., Conclusions: Although BMI was not correlated with 2-year mortality, an increased rate of infectious and device-related AEs was noted in OB and MO LVAD patients. In a group with few options for transplant, the event morbidity in obese patients can be expected to impact morbidity with longer support durations., (Copyright © 2018 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

As of September 30, 2011, a total of 113 patients with end-stage heart failure had undergone heart transplantation in Japan, and the early and late (10-year) survival rates appeared better than those reported by the registry of the International Society of Heart and Lung Transplantation. Among the risk factors negatively affecting survival, utilization of both left ventricular assist devices (LVADs) and marginal donor hearts were higher among Japanese patients, and among the factors favoring survival, younger adult recipients and fewer cases of ischemic cardiomyopathy were noted in Japanese patients. Although only a few patients have reached a survival period longer than 10 years, none has required retransplantation or died due to cardiac allograft vasculopathy (CAV). CAV may develop later in Japanese heart transplant patients than in those with mixed ethnic transplants. In addition, the survival rate with newer LVADs has improved dramatically recently, and therefore selection criteria for the use of an LVAD or heart transplantation require further investigation depending upon the characteristics of candidates with profound heart failure.