LVAD Bridging to Heart Transplantation With Ex Vivo Allograft Preservation Shows Significantly Improved_ Outcomes_ A New Standard of Care

s S95 to compare 1-year survival in patients (pts) receiving a left ventricular assist device (LVAD) as a bridge to transplantation (BTT) or to candidacy (BTC), or HTx from donors ≥ 55 years Methods: Pts receiving a continuous-flow LVAD as BTT/BTC (n= 61) were compared to those undergoing HTx from donors ≥ 55 years (HTx≥ 55y, n= 44 out of 212 adult HTx without prior bridging, 21%) between January 2006 and September 2014. Pts transplanted after LVAD were included in LVAD group only; survival lwas evaluated 1) according to first operation, with pts censored at the time of death or HTx or last follow-up visit, and 2) as overall survival, including postHTx outcome. Results: LVAD and HTx≥ 55y pts differ with respect to gender (Females 9.8 vs 41%, p> 0.005), prior cardiac surgery (11 vs 34%, p= 0.005), hemodynamic (PAPm 38±11 vs 22±8, p> 0.05; PCW 27±8 vs 16±7, p> 0.05). According to first operation, there were 8 deaths in LVAD (13%) and 13 in HTx≥ 55y (32%). Kaplan Meier survival curves estimated a 1-years survival of 87% in LVAD vs 70.5% in HTx≥ 55y pts, (hazard ratio 0.40; 95% confidence interval 0.17-0.97; p= 0.04 for LVAD vs HTx). Early (30 days) mortality was 4.9% in LVAD vs 20.5% in HTx≥ 55y, p0.005) in LVAD than in HTx pts. Nine LVAD pts (14.8%) were transplanted within 1 year, and 7 later; overall survival including post-Htx outcome was 76 % at 1-years. Conclusion: In possible HTx candidates, 1-y survival appears better with LVAD than with HTx from donors≥ 55y, but LVAD complications may require emergency, high risk HTx. Advantages and risks of LVAD or HTx with older donors should be carefully evaluated on an individual basis. Much efforts should be directed to reduce post-LVAD complications, in order to reduce readmissions, and increase the probability of success of subsequent HTx.