Do Patients Supported With Continuous-Flow Left Ventricular Assist Device (CF-LVADS) Have a Sufficient Risk of Death to Justify a Priority Allocation? A Propensity-score Matched Analysis of Patients Listed In UNOS Status 2.

Background: Outcomes of Continuous Flow Left Ventricular Assist Devices (CF-LVADs) as bridge to transplant have significantly improved. The question has arisen whether patients on CF-LVADs have an increased risk of death on the waiting list as to justify a priority allocation (status 1). The aim of this study was to compare the survival following implantation of CF-LVADs to the survival on the waiting list for patients initially listed in United Network for Organ Sharing (UNOS) status 2. Methods: All patients >18 years listed for Heart Transplantation (HT) in the United States between 2011 and 2013 in UNOS status 2 with no mechanical circulatory support at time of listing were analyzed. Patients were divided into two groups depending on whether they received a new CF-LVAD while listed (CF-LVAD group) or not (NO-LVAD) and were further matched on their Propensity Score (PS) in a 1:2 ratio. Results: Two hundreds and eighty-seven CF-LVAD patients were matched to 574 NO-LVAD patients. Survival after CF-LVAD was significantly lower at 24-month compared to waiting list (75.4+4.4 versus 91.2+8.9%, p

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