The influence of preoperative use of ventricular assist devices on survival after heart transplantation: propensity score matched analysis

Objective To determine the influence of the preoperative placement of a left ventricular assist device on survival after heart transplantation. Design Prospective cohort study. Setting Organ sharing database with patient level data on heart transplants in the United States. Participants 2786 adults aged 18 or older in status 1A or 1B (highest priority for heart transplantation with either some form of ventricular assist device, intravenous inotrope, or life expectancy of less than seven days), based on the United Network for Organ Sharing Registry, 1996-2004. Main outcome measure Survival after heart transplantation in patients who did and did not receive a left ventricular assist device. Results The left ventricular assist device was not associated with decreased survival, even after the data were stratified by propensity score (the odds of being a treated patient). Inspection of the strata showed no difference in survival between patients who received the device and those who did not. The hazard ratios in strata 1 to 5 were 0.69, 1.37, 1.55, 0.75, and 1.19, respectively, and none was statistically significant. Conclusion Overall, survival after heart transplantation in patients who received a left ventricular assist device before transplantation was comparable to those who did not receive the device.