Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 153 No. 12 (2023)

Post-transplant survival with pre-transplant durable continuous-flow mechanical circulatory support in a Swiss cohort of heart transplant recipients

  • Roger Hullin
  • Tamila Abdurashidova
  • Barbara Pitta-Gros
  • Sara Schukraft
  • Valentina Rancati
  • Henri Lu
  • Anouck Zurbuchen
  • Carlo Marcucci
  • Zied Ltaief
  • Karl Lefol
  • Christoph Huber
  • Manuel Pascual
  • Piergiorgio Tozzi
  • Philippe Meyer
  • Matthias Kirsch
Cite this as:
Swiss Med Wkly. 2023;153:3500


BACKGROUND: Worldwide, almost half of all heart transplantation candidates arrive today at their transplant operation with durable continuous-flow mechanical circulatory support (CF-MCS). This evolution is due to a progressive increase of waiting list time and hence an increased risk of haemodynamic worsening. Longer duration of CF-MCS is associated with a higher risk of device-related complications with potential adverse impact on post-transplant outcome as suggested by recent results from the United Network of Organ Sharing of the United States.

METHODS: A 2-centre Swiss heart transplantation programme conducted a retrospective observational study of consecutive patients of theirs who underwent a transplant in the period 2008–2020. The primary aim was to determine whether post-transplant all-cause mortality is different between heart transplant recipients without or with pre-transplant CF-MCS. The secondary outcome was the acute cellular rejection score within the first year post-transplant.

RESULTS: The study participants had a median age of 54 years; 38/158 (24%) were females. 53/158 study participants (34%) had pre-transplant CF-MCS with a median treatment duration of 280 days. In heart transplant recipients with pre-transplant CF-MCS, the prevalence of ischaemic cardiomyopathy was higher (51 vs 32%; p = 0.013), the left ventricular ejection fraction was lower (20 vs 25; p = 0.047) and pulmonary vascular resistance was higher (2.3 vs 2.1 Wood Units; p = 0.047). Over the study period, the proportion of heart transplant recipients with pre-transplant CF-MCS and the duration of pre-transplant CF-MCS treatment increased (2008–2014 vs 2015–2020: 22% vs 45%, p = 0.009; increase of treatment days per year: 34.4 ± 11.2 days, p = 0.003; respectively). The primary and secondary outcomes were not different between heart transplant recipients with pre-transplant CF-MCS or direct heart transplantation (log-rank p = 0.515; 0.16 vs 0.14, respectively; p = 0.81).

CONCLUSION: This data indicates that the strategy of pre-transplant CF-MCS with subsequent orthotopic heart transplantation provides post-transplant outcomes not different to direct heart transplantation despite the fact that the duration of pre-transplant assist device treatment has progressively increased.


  1. Jones NR, Roalfe AK, Adoki I, Hobbs FD, Taylor CJ. Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis. Eur J Heart Fail. 2019 Nov;21(11):1306–25. 10.1002/ejhf.1594 DOI:
  2. Crespo-Leiro MG, Metra M, Lund LH, Milicic D, Costanzo MR, Filippatos G, et al. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018 Nov;20(11):1505–35. 10.1002/ejhf.1236 DOI:
  3. Lund LH, Edwards LB, Dipchand AI, Goldfarb S, Kucheryavaya AY, Levvey BJ, et al.; International Society for Heart and Lung Transplantation. The registry of the International Society for Heart and Lung Transplantation: thirty-third adult heart transplantation report - 2016; focus theme: primary diagnostic indications for transplant. J Heart Lung Transplant. 2016 Oct;35(10):1158–69. 10.1016/j.healun.2016.08.017 DOI:
  4. Khush KK, Cherikh WS, Chambers DC, Harhay MO, Hayes D Jr, Hsich E, et al.; International Society for Heart and Lung Transplantation. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-sixth adult heart transplantation report - 2019; focus theme: Donor and recipient size match. J Heart Lung Transplant. 2019 Oct;38(10):1056–66. 10.1016/j.healun.2019.08.004 DOI:
  5. Weiss J, Beyeler F, Immer FF, Swisstransplant H; Swisstransplant Heart Working Group Stah. Heart allocation and transplantation in Switzerland since the introduction of the Swiss Organ Allocation System (SOAS). Swiss Med Wkly. 2014 Nov;144:w14057. 10.4414/smw.2014.14057 DOI:
  6. Zurbuchen A, Tozzi P, Regamey J, Abdurashidova T, Meyer P, Lefol K, et al. Has the Profile of Heart Transplantation Recipients changed within the last 3 decades? An analysis from the Lausanne Heart Transplantation Center. Swiss Med Wkly. 2022;152:w30108. 10.4414/SMW.2022.w30108 DOI:
  7. Miller LW, Pagani FD, Russell SD, John R, Boyle AJ, Aaronson KD, et al.; HeartMate II Clinical Investigators. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 2007 Aug;357(9):885–96. 10.1056/NEJMoa067758 DOI:
  8. Slaughter MS, Pagani FD, McGee EC, Birks EJ, Cotts WG, Gregoric I, et al.; HeartWare Bridge to Transplant ADVANCE Trial Investigators. HeartWare ventricular assist system for bridge to transplant: combined results of the bridge to transplant and continued access protocol trial. J Heart Lung Transplant. 2013 Jul;32(7):675–83. 10.1016/j.healun.2013.04.004
  9. Brisco MA, Kimmel SE, Coca SG, Putt ME, Jessup M, Tang WW, et al. Prevalence and prognostic importance of changes in renal function after mechanical circulatory support. Circ Heart Fail. 2014 Jan;7(1):68–75. 10.1161/CIRCHEARTFAILURE.113.000507 DOI:
  10. Kirklin JK, Naftel DC, Kormos RL, Stevenson LW, Pagani FD, Miller MA, et al. Fifth INTERMACS annual report: risk factor analysis from more than 6,000 mechanical circulatory support patients. J Heart Lung Transplant. 2013 Feb;32(2):141–56. 10.1016/j.healun.2012.12.004 DOI:
  11. Ciarka A, Edwards L, Nilsson J, Stehlik J, Lund LH. Trends in the use of mechanical circulatory support as a bridge to heart transplantation across different age groups. Int J Cardiol. 2017 Mar;231:225–7. 10.1016/j.ijcard.2016.10.049 DOI:
  12. Moonsamy P, Axtell AL, Ibrahim NE, Funamoto M, Tolis G, Lewis GD, et al. Survival after heart transplantation in patients bridged with mechanical circulatory support. J Am Coll Cardiol. 2020 Jun;75(23):2892–905. 10.1016/j.jacc.2020.04.037 DOI:
  13. Zhang B, Guo S, Ning J, Li Y, Liu Z. Continuous-flow left ventricular assist device versus orthotopic heart transplantation in adults with heart failure: a systematic review and meta-analysis. Ann Cardiothorac Surg. 2021 Mar;10(2):209–20. 10.21037/acs-2020-cfmcs-fs-197 DOI:
  14. Fukuhara S, Takeda K, Polanco AR, Takayama H, Naka Y. Prolonged continuous-flow left ventricular assist device support and posttransplantation outcomes: A new challenge. J Thorac Cardiovasc Surg. 2016 Mar;151(3):872–880.e5. 10.1016/j.jtcvs.2015.10.024 DOI:
  15. Takeda K, Takayama H, Kalesan B, Uriel N, Colombo PC, Jorde UP, et al. Outcome of cardiac transplantation in patients requiring prolonged continuous-flow left ventricular assist device support. J Heart Lung Transplant. 2015 Jan;34(1):89–99. 10.1016/j.healun.2014.09.007 DOI:
  16. Uriel MH, Clerkin KJ, Takeda K, Naka Y, Sayer GT, Uriel N, et al. Bridging to transplant with HeartMate 3 left ventricular assist devices in the new heart organ allocation system: an individualized approach. J Heart Lung Transplant. 2022;000:1–10. DOI:
  17. Mullan CW, Chouairi F, Sen S, Mori M, Clark KA, Reinhardt SW, et al. Changes in use of left ventricular assist devices as bridge to transplantation with new heart allocation policy. JACC Heart Fail. 2021 Jun;9(6):420–9. 10.1016/j.jchf.2021.01.010 DOI:
  18. Truby LK, Farr MA, Garan AR, Givens R, Restaino SW, Latif F, et al. Impact of bridge to transplantation with continuous-flow left ventricular assist devices on posttransplantation mortality. Circulation. 2019 Aug;140(6):459–69. 10.1161/CIRCULATIONAHA.118.036932 DOI:
  19. Mihalj M, Heinisch PP, Schober P, Wieser M, Martinelli M, de By TM, et al. Third-generation continuous-flow left ventricular assist devices: a comparative outcome analysis by device type. ESC Heart Fail. 2022 Oct;9(5):3469–82. 10.1002/ehf2.13794 DOI:
  20. Mehra MR, Goldstein DJ, Uriel N, Cleveland JC Jr, Yuzefpolskaya M, Salerno C, et al.; MOMENTUM 3 Investigators. for the MOMENTUM 3 investigators. Two-year outcomes with a magnetically levitated cardiac pump in heart failure. N Engl J Med. 2018 Apr;378(15):1386–95. 10.1056/NEJMoa1800866 DOI:
  21. Schmidhauser M, Regamey J, Pilon N, Pascual M, Rotman S, Banfi C, et al. The impact of multidisciplinary care on early morbidity and mortality after heart transplantation. Interact Cardiovasc Thorac Surg. 2017 Sep;25(3):384–90. 10.1093/icvts/ivx151 DOI:
  22. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015 Mar;16(3):233–70. 10.1093/ehjci/jev014 DOI:
  23. Colvin M, Smith JM, Hadley N, Skeans MA, Uccellini K, Goff R, et al. OPTN/SRTR 2018 Annual Data Report: heart. Am J Transplant. 2020 Jan;20 Suppl s1:340–426. 10.1111/ajt.15676 DOI:
  24. Hullin R, Meyer P, Yerly P, Kirsch M. Cardiac surgery in advanced heart failure. J Clin Med. 2022 Jan;11(3):773–90. 10.3390/jcm11030773 DOI:
  25. Molina EJ, Shah P, Kiernan MS, Cornwell WK 3rd, Copeland H, Takeda K, et al. The Society of Thoracic Surgeons Intermacs 2020 Annual Report. Ann Thorac Surg. 2021 Mar;111(3):778–92. 10.1016/j.athoracsur.2020.12.038 DOI:
  26. Truby LK, Garan AR, Givens RC, Takeda K, Takayama H, Trinh PN, et al. Ventricular assist device utilization in heart transplant candidates. Circ Heart Fail. 2018 Apr;11(4):e004586. 10.1161/CIRCHEARTFAILURE.117.004586 DOI:
  27. Nelson LM, Rossing K, Boesgaard S, Møller-Sørensen H, Møller CH, Gustafsson F, et al. Three decades of heart transplantation: experience and long-term outcome. Scand Cardiovasc J. 2022 Dec;56(1):65–72. 10.1080/14017431.2022.2061726 DOI:
  28. Immohr MB, Mehdiani A, Albert A, Boettger C, Dalyanoglu H, Scheiber D, et al. Heart transplantation in patients with ventricular assist devices: impacts of the implantation technique and support duration. J Card Surg. 2020 Feb;35(2):352–9. 10.1111/jocs.14392 DOI:
  29. Carrozzini M, Bejko J, Gambino A, Tarzia V, Lanera C, Gregori D, et al. Results of new-generation intrapericardial continuous flow left ventricular assist devices as a bridge-to-transplant. J Cardiovasc Med (Hagerstown). 2018 Dec;19(12):739–47. 10.2459/JCM.0000000000000721 DOI:
  30. Wong KL, Ho KL, Lee OJ, Lun KS, Bhatia I, Tam WY, et al. Emerging roles of left ventricular assist device therapy as bridge to transplant in an Asian city with scarce heart transplant donor. J Thorac Dis. 2021 Oct;13(10):5717–30. 10.21037/jtd-21-298 DOI:
  31. Slaughter MS, Rogers JG, Milano CA, Russell SD, Conte JV, Feldman D, et al.; HeartMate II Investigators. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009 Dec;361(23):2241–51. 10.1056/NEJMoa0909938 DOI:
  32. Slaughter MS, Pagani FD, McGee EC, Birks EJ, Cotts WG, Gregoric I, et al.; HeartWare Bridge to Transplant ADVANCE Trial Investigators. HeartWare ventricular assist system for bridge to transplant: combined results of the bridge to transplant and continued access protocol trial. J Heart Lung Transplant. 2013 Jul;32(7):675–83. 10.1016/j.healun.2013.04.004 DOI:
  33. Løgstrup BB, Nemec P, Schoenrath F, Gummert J, Pya Y, Potapov E, et al. Heart failure etiology and risk of right heart failure in adult left ventricular assist device support: the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). Scand Cardiovasc J. 2020 Oct;54(5):306–14. 10.1080/14017431.2020.1781239 DOI:
  34. Hullin R. Heart transplantation: current practice and outlook to the future. Swiss Med Wkly. 2014 Aug;144:w13977. 10.4414/smw.2014.13977 DOI:
  35. Suarez-Pierre A, Lui C, Zhou X, Crawford TC, Fraser CD 3rd, Giuliano K, et al. Early outcomes after heart transplantation in recipients bridged with a HeartMate 3 device. Ann Thorac Surg. 2019 Aug;108(2):467–73. 10.1016/j.athoracsur.2019.01.084 DOI:
  36. Suarez-Pierre A, Zhou X, Fraser CD 3rd, Grimm JC, Crawford TC, Lui C, et al. Survival and functional status after bridge-to-transplant with a left ventricular assist device. ASAIO J. 2019;65(7):661–7. 10.1097/MAT.0000000000000874 DOI:
  37. Alwair H, Whitehouse K, Slaughter MS, Trivedi JR. A tale of two centrifugal-flow ventricular assist devices as bridge to heart transplant. Ann Thorac Surg. 2022 Mar;113(3):757–62. 10.1016/j.athoracsur.2021.03.093 DOI:
  38. de By TM, Schoenrath F, Veen KM, Mohacsi P, Stein J, Alkhamees KM, et al. The European Registry for patients with mechanical circulatory support of the European Association for Cardio-Thoracic Surgery: third report. Eur J Cardiothorac Surg. 2022 Jun;62(1):ezac032. 10.1093/ejcts/ezac032 DOI:
  39. Kormos RL, Cowger J, Pagani FD, Teuteberg JJ, Goldstein DJ, Jacobs JP, et al. The Society of Thoracic Surgeons Intermacs database annual report: evolving indications, outcomes, and scientific partnerships. J Heart Lung Transplant. 2019 Feb;38(2):114–26. 10.1016/j.healun.2018.11.013 DOI:
  40. Immohr MB, Boeken U, Mueller F, Prashovikj E, Morshuis M, Böttger C, et al. Complications of left ventricular assist devices causing high urgency status on waiting list: impact on outcome after heart transplantation. ESC Heart Fail. 2021 Apr;8(2):1253–62. 10.1002/ehf2.13188 DOI:
  41. Hariri IM, Dardas T, Kanwar M, Cogswell R, Gosev I, Molina E, et al. Long-term survival on LVAD support: device complications and end-organ dysfunction limit long-term success. J Heart Lung Transplant. 2022 Feb;41(2):161–70. 10.1016/j.healun.2021.07.011 DOI:
  42. Suarez-Pierre A, Zhou X, Lui C, Grimm JC, Hsu S, Choi CW, et al. Impact of left ventricular assist device exchange on outcomes after heart transplantation. Ann Thorac Surg. 2020 Jan;109(1):78–84. 10.1016/j.athoracsur.2019.05.038 DOI:
  43. Goldstein DJ, Meyns B, Xie R, Cowger J, Pettit S, Nakatani T, et al. Third Annual Report From the ISHLT Mechanically Assisted Circulatory Support Registry: A comparison of centrifugal and axial continuous-flow left ventricular assist devices. J Heart Lung Transplant. 2019 Apr;38(4):352–63. 10.1016/j.healun.2019.02.004 DOI:
  44. Tozzi P, Nowacka A, Hullin R, Yerly P, Kirsch M. The role of Heart Failure Team in managing mechanical circulatory support in a Swiss low-volume institution. Heart Surg Forum. 2018 Jun;21(4):E257–62. 10.1532/hsf.1979 DOI:
  45. Pettit SJ, Jhund PS, Hawkins NM, Gardner RS, Haj-Yahia S, McMurray JJ, et al. How small is too small? A systematic review of center volume and outcome after cardiac transplantation. Circ Cardiovasc Qual Outcomes. 2012 Nov;5(6):783–90. 10.1161/CIRCOUTCOMES.112.966630 DOI:
  46. Potapov EV, Antonides C, Crespo-Leiro MG, Combes A, Färber G, Hannan MM, et al. 2019 EACTS Expert Consensus on long-term mechanical circulatory support. Eur J Cardiothorac Surg. 2019 Aug;56(2):230–70. 10.1093/ejcts/ezz098 DOI:

Most read articles by the same author(s)

1 2 > >>