Sex-Related Differences in Use and Outcomes of Left Ventricular Assist Devices as Bridge to Transplantation

Ersilia M. DeFilippis, Lauren K. Truby, A. Reshad Garan, Raymond C. Givens, Koji Takeda, Hiroo Takayama, Yoshifumi Naka, Jennifer H. Haythe, Maryjane A. Farr, Veli K. Topkara

Research output: Contribution to journalArticlepeer-review

40 Scopus citations

Abstract

Objectives: This study examined sex-related differences in use and outcomes of continuous-flow left ventricular assist devices (CF-LVADs) among individuals awaiting heart transplantation using the United Network for Organ Sharing registry. Background: Advanced therapies for heart failure including CF-LVADs remain underused in women. There have been contradictory results regarding sex-specific outcomes. Many studies have been limited by small sample sizes or included pulsatile-flow devices. Methods: De-identified patient-level data were obtained from the United Network for Organ Sharing database. The database was queried to identify adult patients (≥18 years of age) who required mechanical circulatory support with HeartWare HVAD (Medtronic, Minneapolis, Minnesota), HeartMate II (Abbott, Lake Bluff, Illinois), or HeartMate 3 (Abbott) as bridge to heart transplantation between 2008 and 2018. Each patient was assigned a propensity score. The primary outcomes of interest were rates of transplantation and death. Results: A total of 13,305 patients (2,771 women, 20.8%) received support with CF-LVAD in the study period. There were significant sex disparities in CF-LVAD use in listed patients (29.9% men vs. 18.9% women in 2017). Female patients receiving CF-LVAD support had lower chances of heart transplantation (55.1% vs. 67.5%), increased risk of waitlist mortality (7.0% vs. 4.2%), and delisting for worsening clinical status (8.5% vs. 4.7%) at 2 years post-implantation (all p < 0.001). After adjusting for device type, sex was still a significant predictor of waitlist mortality (hazard ratio: 1.51; p < 0.001). Conclusions: Durable mechanical circulatory support with CF-LVADs remains underused in women. When matched with similar male control subjects, women experienced higher mortality and lower rates of heart transplantation.

Original languageEnglish (US)
Pages (from-to)250-257
Number of pages8
JournalJACC: Heart Failure
Volume7
Issue number3
DOIs
StatePublished - Mar 2019
Externally publishedYes

Keywords

  • heart transplantation
  • sex
  • ventricular assist device

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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