“Durable Left Ventricular Assist Devices as a Bridge to Transplantation in The Old and The New World”

Introduction Heart transplantation remains the gold standard treatment for end-stage heart failure patients without contraindications. However, limited donor availability and long wait times have created a need for left ventricular assist devices (LVAD) to be used as a bridge to transplantation (BTT) in appropriately selected patients. Methods This review provides an overview of the current state of heart transplantation in the US and Europe, with a particular focus on how distinct allocation policies and organ availability impact medical practices. Results LVAD utilization as BTT exhibits notable disparities worldwide, mainly due to variations in organ availability, allocation policies, and financial constraints. Although Europe has experienced a consistent increase in the use of LVAD for this purpose, the United Network for Organ Sharing 2018 policy amendment resulted in a significant reduction in the number of LVADs used for BTT in the US. Discussion Given the features of the US transplant allocation system, the BTT indication is likely to remain as a minority. To overcome this issue, modifications in the US allocation policy to consider factors such as days on device support, age, and type of complications may be necessary to potentially increase implantation rates. Meanwhile, due to a shortage of donors and the increasing expertise in the advanced heart failure field, the utilization of LVAD in Europe is expected to see gradual growth.