Work

Exercise capacity after mechanical circulatory support compared to heart transplant in advanced heart failure

Year: 2026

Type: article

Abstract: Background In advanced heart failure patients, both ventricular assist device (VAD) and orthotopic heart transplant (OHTx) lead to markedly improved outcomes compared to medical therapy, with OHTx being the therapy of choice. Whilst OHTx offers superior survival compared to VAD, it is also assumed that OHTx results in greater exercise capacity, however this has not been formally examined. In this study, we evaluated the exercise capacity of patients following VAD and OHTx after a structured outpatient rehabilitation program. Methods We performed a retrospective single-centre cohort study of patients undergoing OHTx or VAD at a large tertiary centre from January 2022 to January 2024. All patients underwent a standardised outpatient exercise program for a minimum of 3 months following surgery. Maximal and 3-month 6MWT were recorded in each group. Comorbidities including age, gender, diabetes mellitus (DM), renal impairment, lung disease and hospital stay were recorded and the option of either OHTx or VAD were used as inputs in a multivariate linear regression model for prediction of 3-month 6MWT. The three major factors identified were then added as covariates in the combined OHTx and VAD cohort to determine predictors of 6MWT. Results A total of 78 patients (60 OHTx, 18 VAD; median age 51.5(44.3-59.0) years; 62 male) were included. The maximal recorded 6MWT was similar between both cohorts (median 6MWT OHTx: 534.0 (478.8-600.3)m; VAD: 608.5 (487.0-643.5)m, p=0.30). Gender was a significant predictor of 6MWT in the OHTx cohort (β=-69.1, p<0.02) with a strong trend also in the VAD cohort (β=-199, p<0.09). All other comorbidities were not significantly associated with 6MWT in the VAD or OHTx subgroups. In patients undergoing OHTx with a prior VAD, VAD was not predictive of 3-month 6MWT after OHTx (p=0.99). After accounting for major covariates, the option of VAD or OHTx in the combined cohort was not predictive of 3-month 6MWT (p=0.88). Conclusion In advanced heart failure patients, when compared to OHTx, VAD is associated with a similar level of exercise capacity, and did not impact exercise capacity in patients undergoing OHTx who are bridged with a VAD. In OHTx patients, gender was the strongest predictor of exercise capacity with a significantly lower 6MWT in females.

Source: JHLT Open

DOI: 10.1016/j.jhlto.2026.100484