Abstract 4373096: Inpatient Outcomes After Heart Transplantation With and Without LVAD Bridging

Introduction: Heart failure (HF) is one of the leading causes of hospitalization and mortality in the United States. Heart transplantation (HT) remains the definitive treatment for end-stage HF, sometimes preceded by left ventricular assist device (LVAD) implantation as a bridge to transplant. However, national data on inpatient outcomes for HT recipients with and without LVAD bridging remain limited. Methods: We analyzed the Nationwide Readmissions Database (NRD) from 2016–2019 to identify adult patients who underwent HT and were discharged between January and November of each year. Patients with missing data on event time or length of stay were excluded. Survey-weighted procedures were applied to account for the complex sampling design. We compared inpatient outcomes between patients who received LVAD implantation during the same index hospitalization and those who did not. Data were analyzed using SAS 9.4. Results: We identified 11,351 weighted adult patients who underwent HT from January to November 2016–2019. Of these, 2% (n=233) received LVAD during the same index hospitalization. LVAD recipients were younger (mean age: 50.7 vs. 53.3 years) and less likely to be female (23% vs. 27%) compared to non-LVAD patients. They also had higher rates of comorbidities, including acute encephalopathy (35% vs. 15%), advanced chronic kidney disease (19% vs. 9%), and cardiac cachexia (42% vs. 21%) (all p < 0.001). LVAD recipients required more intensive inpatient interventions, such as percutaneous coronary intervention (1.7% vs. 0.6%), coronary artery bypass grafting (3.4% vs. 0.2%), intra-aortic balloon pump (27% vs. 19%), extracorporeal membrane oxygenation (28% vs. 9%), and peripheral VAD (63% vs. 4%) (all p < 0.001). These patients experienced longer hospital stays (mean: 85 vs. 38 days) and higher inpatient mortality (15% vs. 5%, p < 0.0007), as well as greater 30-day readmission mortality (1.3% vs. 0.2%, p = 0.01). Multivariable analysis identified acute encephalopathy, coagulopathy, and cardiac cachexia as independent predictors of inpatient mortality after adjusting for age, sex, kidney disease, and LVAD bridging. Conclusion: Heart transplant recipients requiring LVAD implantation during the same hospitalization experience significantly worse inpatient outcomes, including higher mortality and resource utilization. Early identification and risk stratification of these patients may help guide perioperative management and improve outcomes.