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Patients with severe heart disease may require hemodynamic support with a durable left ventricular assist device (LVAD) as a bridge to heart transplantation (HTx). Techniques to implant these durable LVADs do vary from institution to institution. Use of various materials to separate tissues also vary amongst implanting institutions. When these patients move to another facility, explanting these LVADs may be more problematic when undergoing HTx. It is not known whether explantation of an LVAD performed at another institution is fraught with more complications. Between January 2010 and June 2021, we evaluated 176 patients who had durable LVAD explanted at the time of HTx. Patients were separated into those that had durable LVAD performed at our transplant hospital versus those that were placed at an outside facility. The following endpoints were obtained: number of blood products administered, primary graft dysfunction, vasoplegia, intraoperative vascular complications, time in the operating room (OR), and 30-day post-HTx survival. Durable LVADs placed at an outside facility compared to those placed internally led to a trend in increased intraoperative complications during HTx surgery. However, there was no significant difference in blood products used, OR time, primary graft dysfunction, vasoplegia, and 30-day survival between the 2 study groups. Durable LVADs placed at an outside institution poses an increased risk for peri-operative complications when bridging to HTx. Extra time should be afforded to compensate for these potential problems. [ABSTRACT FROM AUTHOR]

There are many reports in solid organ transplantation that demonstrate that there are sex discrepancies in waitlist urgent status, time on the transplant waitlist, and waitlist mortality. There should be no differences in men versus women in the percent of patients with severe heart disease. The new donor heart allocation policy change took place in October 2018, and provided the sickest patients with the highest priority for donor hearts. We chose to assess our male and female patients to establish whether there exists a difference in patients listed as urgent status on the heart transplant (HTx) waitlist. Between November 2018 and December 2020 (after donor heart allocation change in October 2018), we assessed 276 patients on our HTx waitlist. Patients on the HTx waitlist were followed for 6 months and censored after they were transplanted or removed from the waitlist. Percent of patients of each sex listed as urgent status (status 1, 2, 3) was recorded. Mortality on the waitlist, waitlist time, and removal from the waitlist due to being too sick were secondary endpoints. After the donor heart allocation policy change in October 2018, women were significantly less likely to be listed as urgent status compared to men. For those patients listed as urgent status, there was no significant difference in mortality for women versus men on the HTx waitlist. Average waitlist time was similar between the 2 groups. (see table) There appears to be a sex disparity for women being less likely to be listed as urgent status on the HTx waitlist. Further studies are needed to determine whether this difference has a biologic mechanism or whether there is selection bias and/or treatment bias present in their care. [ABSTRACT FROM AUTHOR]