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. 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. 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. 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.

中文翻译：

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“耐用的左心室辅助装置作为新旧世界移植的桥梁”


心脏移植仍然是无禁忌症的终末期心力衰竭患者的金标准治疗方法。然而，有限的供体可用性和漫长的等待时间导致需要将左心室辅助装置（LVAD）用作适当选择的患者的移植桥梁（BTT）。这篇综述概述了美国和欧洲心脏移植的现状，特别关注不同的分配政策和器官可用性如何影响医疗实践。 LVAD 作为 BTT 的利用在世界范围内表现出显着差异，这主要是由于器官可用性、分配政策和财务限制的差异。尽管欧洲为此目的 LVAD 的使用持续增加，但联合器官共享网络 2018 年政策修正案导致美国用于 BTT 的 LVAD 数量大幅减少。鉴于美国移植分配系统的特点，BTT 适应症可能仍占少数。为了克服这个问题，可能有必要修改美国的分配政策，考虑设备支持天数、年龄和并发症类型等因素，以潜在地提高植入率。同时，由于供体短缺以及晚期心力衰竭领域专业知识的不断增加，欧洲 LVAD 的使用预计将逐步增长。