Introduction: LVAD utilization has increased in the face of continuing donor shortage. These patients may remain at the highest urgency status of UNOS 1A electively for 30 days. Upon completion of this time, LVAD patients may only regain this status with device complications. Trends in device complications of those undergoing HT have not been well-described. We sought to assess the trend of 1A exceptions in this population.
Methods: 3551 HT recipients bridged with LVAD of 10,634 were identified from UNOS (2000-2015) were stratified by UNOS 1A listing exception: device infection, thromboembolism, device malfunction, life-threatening ventricular arrhythmia or other. Exclusions: age<18, re-HT & lost to follow up. Survival was censored at 12y. UNOS 1A listing exceptions over time were assessed via a nonparametric test for trend.
Results: 3551 HT recipients bridged with LVAD with the following 1A exceptions: device infection (n=1516), thromboembolism (n=517), device malfunction (n=585), life-threatening ventricular arrhythmia (n=196) and other (n=737). During the study period, listing for each of these complications increased over time (Figure). Overall survival in patients listed with MCS exception was (1, 5 & 10y): 87, 74 & 56%. Survival by 1A exception is shown in Figure. Survival was significantly reduced in those with device infection (1, 5 & 10y: 85, 70, 50%; log rank, p=0.007).
Conclusions: UNOS 1A listing exceptions in LVAD patients have increased over time. Despite this increase, short and long-term survival does not appear to be impacted with the exception of device infection. Further study is warranted to explore this increase in exceptions and impaired outcomes in the device infection population.