Equivalent Improvement in Exercise Capacity after Mechanical Circulatory Support Compared to Heart Transplant in Advanced Heart Failure

Presenter: Hazel Lo

In advanced heart failure patients, both ventricular assist devices (VAD) and orthotopic heart transplantation (OHTx) significantly improve outcomes. Although OHTx is preferred for survival, this study found no significant difference in exercise capacity between VAD and OHTx patients after a structured rehabilitation program.

Among 78 patients, maximal and 3-month six-minute walk test (6MWT) results were comparable. Multivariate analysis showed gender and diabetes mellitus were significant predictors of reduced 6MWT, while age and hospital stay showed strong trends. The choice between VAD and OHTx did not influence 3-month 6MWT. Female gender consistently predicted lower exercise capacity across both groups.

Impact of HF Pharmacological Therapy on The Durability of Favorable Response after LVAD Weaning: A VAD Wean Registry Analysis

Presenter: Stavros Drakos

In this multicenter study of 407 heart failure patients weaned from durable LVAD support, researchers assessed the impact of guideline-directed medical therapy (GDMT) on long-term outcomes.

Patients were categorized as responders or partial responders based on cardiac recovery. Post-weaning use of beta-blockers (90%) and ACEi/ARBs/ARNIs (84%) was significantly associated with improved 5-year survival free from transplant or LVAD re-implantation, even after adjusting for age, sex, and weaning indication. Mineralocorticoid antagonist use (64%) showed no significant benefit. These findings highlight the critical role of continued GDMT in sustaining favorable outcomes after LVAD withdrawal.

Frailty and Obesity in Heart Transplant Recipients: Impact on Post-Transplant Mortality

Presenter: Thomas Goubar

In a retrospective study of 268 heart transplant recipients, researchers examined the combined impact of frailty and obesity on post-transplant mortality.

Frailty was assessed using Fried’s Frailty Phenotype, and obesity was defined as BMI ≥ 30 kg/m². Patients were grouped into four frailty-obesity categories. Mortality was lowest in non-frail non-obese individuals and highest in frail-obese patients. Cox regression analysis showed frail-obese patients had the greatest mortality risk (HR = 2.66), followed by frail non-obese (HR = 1.96). Obesity did not mitigate frailty-related risk. These findings emphasize the need for frailty screening in all transplant candidates, regardless of BMI.

Clinical Impact of Frailty after Durable Left Ventricular Assist Device Implantation

Presenter: Shingo Kazama

In a nationwide Japanese registry study of 1,457 patients with durable LVADs (dLVAD), frailty was assessed three months post-implantation using a 31-item Frailty Index (FI).

Patients were categorized as not frail, more frail, or most frail. Frailty was common, with 67.5% classified as frail. Over a median 3.4-year follow-up, higher frailty severity was significantly associated with increased mortality (HR 1.97 for more frail; HR 5.01 for most frail), hemocompatibility events, and right ventricular failure. These associations persisted after adjustment for confounders. The findings underscore frailty’s prognostic value and support its use in post-LVAD risk stratification and targeted interventions.

Impact of Delayed Heparin Bridging on Bleeding and Stroke after Heartmate 3 Left Ventricular Assist Device Implantation

Presenter: Parsa Jahangiri

In a single-center retrospective study of 167 patients undergoing HeartMate 3 LVAD implantation, researchers compared two anticoagulation protocols.

The new protocol delayed heparin initiation to beyond 48 hours postoperatively, while the old protocol began at 24 hours. The new protocol significantly reduced bleeding or tamponade events requiring reoperation (21% vs. 42%, p = 0.006) and shortened both hospital (22 vs. 26 days, p = 0.003) and ICU stays (3 vs. 6 days, p = 0.020), without increasing ischemic stroke risk (p = 0.23). Thirty-day mortality was similar. These findings support delayed anticoagulation as a safer strategy post-LVAD implantation.

Efficacy and Safety of Antithrombotic Regimens in Patients with Durable Left Ventricular Assist Devices: A Systematic Review and Bayesian Network Meta-Analysis

Presenter: Maria Clara Ramos Miranda

In a systematic review and Bayesian network meta-analysis of 972 heart failure patients with durable LVADs, three antithrombotic regimens were compared: vitamin K antagonist (VKA) monotherapy, VKAs plus aspirin (ASA), and direct oral anticoagulants (DOACs) plus ASA.

VKA monotherapy significantly reduced non-surgical bleeding (OR 0.21) and gastrointestinal bleeding (OR 0.33) compared to VKAs plus ASA, with no increase in thrombotic events. No significant differences were found between DOACs plus ASA and other regimens. SUCRA rankings favored VKA monotherapy for minimizing bleeding and ischemic events. These findings suggest VKA monotherapy may offer a safer anticoagulation strategy, though further high-quality trials are needed to guide clinical practice.

Ref: ESC Congress 2025, 29^thAug- 1^st Sept 2025, Spain