IMR Press / RCM / Volume 25 / Issue 2 / DOI: 10.31083/j.rcm2502068
Open Access Review
Bridging Over Troubled Waters—How the United States 2018 Heart Allocation System Altered Transplant Bridging Strategies
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1 Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY 10010, USA
*Correspondence: (Les James)
Rev. Cardiovasc. Med. 2024, 25(2), 68;
Submitted: 23 May 2023 | Revised: 11 September 2023 | Accepted: 22 September 2023 | Published: 20 February 2024
Copyright: © 2024 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

As we approach the five-year anniversary of the 2018 heart allocation system in the United States, it is imperative to consider the changing landscape of mechanical circulatory support and the strategies used to bridge patients into heart transplants. This manuscript reviews the history of the heart allocation system, as well as the conditions that led to its multiple revisions. We discuss initial outcomes following the implementation of the new allocation system, including the impact on waitlist mortality and post-transplant outcomes. We also give special consideration to changes in bridging strategies using venoarterial extracorporeal membrane oxygenation (VA ECMO), intra-aortic balloon pumps, and durable left ventricular assist devices (LVADs).

heart transplantation
bridging strategies
mechanical support
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