Comparison of waitlist and post‐transplant outcomes in patients supported with total artificial heart versus continuous biventricular assist devices.

Background: Durable biventricular support may be necessary to bridge patients with end‐stage biventricular failure to heart transplantation. This study compares waitlist and post‐transplant outcomes between patients supported with continuous flow, durable biventricular assist devices (BiVAD), and total artificial heart (TAH). Methods: Using the UNOS registry, we analyzed adult (≥18 years old), first‐time transplant candidates with TAH or BiVAD at the time of listing or transplantation from 10/1/2010–10/31/2020, with follow‐up through 3/31/2022. Multivariable proportional subdistribution hazards models and cause‐specific Cox proportional hazards models were used to compare death/deterioration or heart transplantation on the waitlist between cohorts. Kaplan–Meier and multivariable Cox proportional hazards model were used to evaluate one‐year post‐transplant survival and evaluate difference in outcomes based on annual transplant center volume. Results: The waitlist cohort included a total of 228 patients (25% BiVAD). Waitlist outcomes between device types were similar. The transplanted cohort included a total of 352 patients (25% BiVAD). There was a trend towards worse one‐year post‐transplant survival in patients bridged with TAH versus BiVAD (log‐rank p‐value = 0.072) that persisted after adjusting for age, gender, policy, and removing dual‐organ recipients (HR 1.94 (0.94, 3.98) p‐value = 0.07). There was a difference in one‐year post‐transplant survival amongst TAH‐bridged patients when stratified by annual transplant center volume (log‐rank p‐value = 0.013). One‐year post‐transplant survival between TAH‐supported patients from high annual transplant volume centers and BiVAD‐supported patients was similar (p‐value = 0.815). Conclusions: BiVAD and TAH are reasonable support strategies with TAH implantation at high‐volume transplant centers (51+ transplants/year) having similar 1‐year post‐transplant survival to BiVAD‐supported patients. [ABSTRACT FROM AUTHOR]