The LVAD Paradox in Heart Transplantation: Higher Risk of Primary Graft Dysfunction, Yet Improved Survival Outcomesdszcx

Highlights

• Durable left ventricular assist device (LVAD) support is associated with a significantly higher incidence of severe primary graft dysfunction (PGD) after heart transplantation (12.7% vs 7.4%).
• Paradoxically, LVAD-supported patients who develop severe PGD have a significantly lower 1-year mortality rate (28.8%) compared to non-LVAD patients with severe PGD (40.7%).
• Key clinical risk factors for severe PGD in the LVAD population include elevated pre-transplant creatinine, high CVP/PCWP ratios, and prolonged donor ischemic time.
• Venous congestion surrogates are more predictive of PGD in the LVAD population than traditional hemodynamic markers.

The Evolving Landscape of Bridge-to-Transplant