Bridge-to-Bridge Left Ventricular Assist Device Implantation Strategy vs. Primary Left Ventricular Assist Device Implantation Strategy

Teruhiko Imamura, Koichiro Kinugawa, Minoru Ono, Norihide Fukushima, Akira Shiose, Yoshiro Matsui, Kenji Yamazaki, Yoshikatsu Saiki, Goro Matsumiya, Hirokuni Arai, Yoshiki Sawa

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Background: The bridge-to-bridge (BTB) strategy, a conversion to durable left ventricular assist device (LVAD) after stabilization using surgical temporary mechanical circulatory supports for a couple of months, is not uncommon in Japan. However, its effect on clinical outcomes in comparison with a primary durable LVAD implantation strategy remains unknown. Methods and Results: Data of 837 consecutive patients (median age 45, 73% males) who underwent durable LVAD implantation as BTB (n=168) or primary implant (n=669) between April 2011 and April 2019 were retrospectively reviewed from the prospective multicenter Japanese mechanically assisted circulatory support registry. The BTB group was younger and had comparable end-organ function, better hemodynamic profile, and longer operative time compared with the primary implant group at baseline. The 3-year survival was 80% vs. 87% (P=0.007) for the BTB and primary implant groups respectively, with greater observed rates of stroke and infection as the predominant causes of death. The BTB strategy was independently associated with increased 3-year mortality (hazard ratio 2.69 [1.43–5.07], P=0.002) in addition to other significant risk factors. Conclusions: The BTB cohort had comparable baseline characteristics to the primary implant cohort at the time of durable LVAD conversion, but had lower 3-year survival. Detailed analysis clarifying the causality of this finding should improve outcomes with the BTB strategy.

Original languageEnglish
Pages (from-to)2198-2204
Number of pages7
JournalCirculation Journal
Issue number12
Publication statusPublished - 2020

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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