Net prolongation of life in advanced heart failure: an intentional strategy of durable LVAD therapy followed by heart transplantation
Bernhardt, Alexander M Kanwar, Manreet K Kittleson, Michelle Cowger, Jennifer A Pagani, Francis D Gallone, Guglielmo Gosev, Igor Wood, Katherine Zuckermann, Andreas Poglajen, Gregor
Bernhardt, Alexander M
Kanwar, Manreet K
Kittleson, Michelle
Cowger, Jennifer A
Pagani, Francis D
Gallone, Guglielmo
Gosev, Igor
Wood, Katherine
Zuckermann, Andreas
Poglajen, Gregor
Abstract
Heart transplantation (HT) and durable left ventricular assist device (LVAD) support are established surgical treatment options for patients with end-stage systolic heart failure (HF) and/or nonrecoverable cardiogenic shock. HT is currently considered the gold standard therapy, with reported median survival of approximately 10-13 years. However, its utility in the lifetime management of younger patients (under 50 years of age) is limited, given low rates of re-transplantation. With continued advancements in durable LVAD technology, median survival following LVAD implantation in younger patients now exceeds 7 years. In an era marked by increasing HF prevalence, persistent donor heart shortages, evolving organ allocation policies, growing concerns regarding equity of care, and progress in the cardiac function enhancement therapies, LVAD and HT should be considered synergistic rather than competing therapies in selected advanced HF populations. Specifically, the strategy of intentional LVAD implantation as a first-line approach in transplant-eligible younger adults and older adolescents might extend the therapeutic horizon and optimize lifetime management.
MIDER Authors
Affiliations
University Hospital Hamburg-Eppendorf; University of Chicago; Cedars-Sinai Medical Center; Michigan State University; University of Turin; Newark Beth Israel Medical Center; UCI Health Cardiovascular Center; Medical University of Vienna; Ljubljana University Medical Centre; The University of Texas Southwestern Medical Center; University Hospitals Birmingham NHS Foundation Trust; University of Birmingham; Dokkyo University Saitama Medical Center; Azienda Ospedaliera dei Colli; Columbia University Irving Medical Center; Deutsches Herzzentrum der Charité; Northwell Health; University of Utah
Date
2026-03-13
Type
Article
Collections
Citation
Bernhardt AM, Kanwar MK, Kittleson M, Cowger JA, Pagani FD, Gallone G, Gosev I, Wood K, Zuckermann A, Poglajen G, Farr M, Lim HS, Toda K, Amarelli C, Brailovsky Y, Loforte A, Knosalla C, Schrage B, Patel SR, Drakos SG, Uriel NJ. Net Prolongation of Life in Advanced Heart Failure: An Intentional Strategy of Durable LVAD Therapy Followed by Heart Transplantation. J Heart Lung Transplant. 2026 Mar 13:S1053-2498(26)01770-5. doi: 10.1016/j.healun.2026.03.006. Epub ahead of print.