A Comparative Analysis Of Complications After Heart Transplantation And Left Ventricular Assist Devices In The United States - A National Readmission Database Study.

Orthotropic heart transplantation (OHT) remains the gold standard for end-stage heart failure, with left ventricular assist devices (LVAD) being offered as a bridge to transplant or as destination therapy when OHT cannot be performed. Advancements in LVAD technology and evolving organ allocation policies have shifted the dynamics between LVAD and OHT usage. This study leverages a nationwide database to compare index admission complications between OHT and LVAD recipients, providing critical insights into their real-world clinical implications. Our study population was derived from the 2018-2020 Nationwide Readmissions Database (NRD) from the Healthcare Cost and Utilization Project of the United States Agency for Healthcare Research and Quality. In our retrospective analysis, we examined data spanning from January 2018 to December 2020, focusing on individuals aged 18 years and older who were identified as recipients of OHT or newer generation centrifugal LVAD implantation. During the study, 4989 (48.66%) patients received OHT and 5263 (51.34%) received LVAD. In the comparative analysis we observed that, OHT patients had a lower risk of dysrhythmias (aOR: 0.66; CI: 0.57-0.76; p<0.001), acute myocardial infarction (AMI) (aOR: 0.41; CI: 0.20-0.85; p=0.01), respiratory failure (aOR: 0.78; CI: 0.66-0.93; p<0.001), electrolyte disorders (aOR: 0.84; CI: 0.73-0.95; p<0.001), valve disorders (aOR: 0.61; CI: 0.50-0.75; p<0.001), hepatic failure (aOR: 0.55; CI: 0.43-0.70; p<0.001), and severe sepsis (aOR: 0.67; CI: 0.53-0.85; p<0.001), compared to LVAD patients. However, patients undergoing OHT had an increased risk of acute renal failure (aOR: 1.22; CI: 1.04-1.43; p=0.012) and pericarditis (aOR: 1.61; CI: 1.37-1.89; p<0.001). OHT patients were found to have a higher likelihood of post-procedural surgical complications (aOR: 1.44; CI: 1.11-1.88; p<0.001). Gastrointestinal bleeding presented a similar risk for both groups (aOR: 0.67; CI: 0.45-1.00; p=0.05) (Figure 1). Despite technological advancement, LVAD still carries higher complication risks during the initial hospital stay compared to OHT. [ABSTRACT FROM AUTHOR]