Meta-Analysis of Durable Compared to Temporary Left Ventricular Assist Devices Compared to Venoarterial Extracorporeal Membrane Oxygenation for Bridging to Heart Transplantation or Treatment of Primary Graft Dysfunction

Sep 30, 2026

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Meta-analysis evaluating survival differences by circulatory support type in patients bridged to heart transplantation (HTx) and in those with primary graft dysfunction (PGD) after HTx. Survival was compared across durable left ventricular assist devices (d-LVAD), temporary LVADs (t-LVAD), and venoarterial extracorporeal membrane oxygenation (VA-ECMO). Random-effects models pooled four HTx-bridging studies (n=1678) and three PGD studies (n=35). One-year survival was higher with t-LVAD and d-LVAD than with VA-ECMO, while 30-day PGD survival was complete for t-LVAD.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

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Abstract

Background

Methods

Results

Conclusions

1. Introduction

2. Materials and Methods

2.1 Study Design

2.2 Eligibility Criteria

Rev. Cardiovasc. Med. 2025; 26(12): 45064 [https://doi.org/10.31083/RCM45064](https://doi.org/10.31083/RCM45064) Systematic Review Meta-Analysis of Durable Compared to Temporary Left Ventricular Assist Devices Compared to Venoarterial Extracorporeal Membrane Oxygenation for Bridging to Heart Transplantation or Treatment of Primary Graft Dysfunction Lars Saemann 1 , *, Sven Maier2 , Matthias Kohl3 , Andreas Simm 1 , Gábor Szabó 1 ,4 1Department of Cardiac Surgery, University Hospital Halle, 06120 Halle (Saale), Germany 2Department of Cardiac Surgery, University Hospital Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany 3Faculty III: Health, Medical Life Sciences, Furtwangen University of Applied Sciences, 78054 Villingen-Schwenningen, Germany 4Department of Cardiac Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany *Correspondence: [Lars.saemann@uk-halle.de](Lars.saemann@uk-halle.de) (Lars Saemann) Academic Editor: Michael Dandel Submitted: 16 July 2025 Revised: 23 September 2025 Accepted: 10 October 2025 Published: 16 December 2025 Abstract Background: Patients bridged to heart transplantation (HTx) and patients with primary graft dysfunction (PGD) after HTx are typically treated with circulatory support. However, the survival of patients in both indications might depend on the type of circulatory support. Thus, this meta-analysis aimed to investigate the survival of HTx patients supported during bridging with a durable left ventricular assist device (d-LVAD), a temporary LVAD (t-LVAD), or venoarterial extracorporeal membrane oxygenation (VA-ECMO). We also investigated the survival rate of patients with PGD by type of circulatory support device. Methods: We performed a random-effects meta-analysis. Results: We included four studies evaluating bridging to HTx (n = 1678 patients) and three studies for the PGD analysis (n = 35 patients) . The 1-year survival after HTx was significantly higher in patients bridged with a t-LVAD (92.7%; 95% confidence interval (CI): 89.2 to 95.6%; p = 0.027) and with a d-LVAD (86.8%; 95% CI: 75.8 to 94.8%; p = 0.001) compared to VA-ECMO (71.6%; 95% CI: 63.7 to 78.9%) . The 30-day survival in patients with PGD and t-LVAD was 100%(95% CI: 59.2–100%), while with PGD and VA-ECMO, survival was 92.4%(95% CI: 66 to 100%) . Conclusions: Both d-LVAD and t-LVAD bridging methods appear to have comparable 1-year survival rates, which are higher than those after VA-ECMO bridging. Nonetheless, more prospective clinical studies are needed to investigate outcomes after using circulatory support devices for PGD after HTx. The PROSPERO registration: CRD420251149065, [https://www.crd.york.ac.uk/PROSPERO/view/CRD420251149065](https://www.crd.york.ac.uk/PROSPERO/view/CRD420251149065) . Keywords: left ventricular assist device; extracorporeal membrane oxygenation; venoarterial; impella; heart transplantation; primary graft dysfunction; bridging to transplant 1. Introduction For patients with end-stage heart failure, heart transplantation (HTx) is the gold standard of therapy. However, patients are increasingly bridged to HTx with a circulatory support system [1] . Most commonly, a durable left ventricular assist device (d-LVAD), which needs to be implanted surgically, has been used for bridging [1] . It unloads the left ventricle through the pump inflow tract implanted through the apex, pumping the blood back into the aorta through the anastomosed outflow tract. Meanwhile, temporary left ventricular assist devices (t-LVAD), which can be inserted percutaneously through the femoral or axillary artery and provide adequate flow rates to maintain circulation in the body, are available in the market. T-LVADs are inserted into the left ventricle through the aorta, and amicroaxial pump unloads the left ventricle. These t-LVADs, even when approved only for temporary support, are also increasingly used for bridging the patient to HTx [2] . Finally, veno-arter

FAQs

What patient groups were analyzed in this meta-analysis?

Patients bridged to heart transplantation and patients with primary graft dysfunction (PGD) after heart transplantation were analyzed, with outcomes compared across device types.

Which circulatory support devices were compared for bridging to heart transplantation?

Durable LVAD (d-LVAD), temporary LVAD (t-LVAD), and venoarterial VA-ECMO were compared for survival after bridging to HTx.

What were the main survival findings across device types?

One-year survival after HTx was significantly higher with t-LVAD and d-LVAD than with VA-ECMO. For PGD, 30-day survival was 100% with t-LVAD and 92.4% with VA-ECMO.

Sep 30, 2026

Uploaded by Stanley