{"doi":"10.1016/j.xjon.2025.10.036","title":"High-volume centers achieve superior outcomes in left ventricular assist device explant-heart transplantation","abstract":"Background Left ventricular assist device ( LVAD) explantation at the time of orthotopic heart transplantation (OHT) carries increased perioperative risks. This study examined whether institutional operative volume influences outcomes following LVAD explant-OHT in a contemporary national cohort. Methods Adult patients who underwent LVAD explantation with OHT between 2011 and 2024 were identified in the Organ Procurement and Transportation Network/United Network for Organ Sharing registry. Using a rank-order method based on surgical volume, centers were stratified as either high volume or low volume. The primary outcome was 1-year survival; secondary outcomes included graft failure, ischemic time, dialysis, stroke, and hospital length of stay. Kaplan-Meier and Cox regression analyses were performed to assess survival and predictors of mortality. Results A total of 2863 patients across 121 centers were analyzed. Eight high-volume centers performed 31.3% (897 cases) of all LVAD explant-OHTs. Baseline characteristics, including heart failure etiology and LVAD device type, were similar in the 2 groups. High-volume centers demonstrated decreased ischemic time (mean, 3.1 ± 1.3 hours vs 3.5 ± 1.4 hours; P < .001), a lower rate of postoperative dialysis (12.7% vs 15.4%; P = .023), and shorter length of stay (mean, 22.8 ± 26.6 days vs 25.9 ± 31.3 days; P = .006) compared to low-volume centers. Graft failure was less common at high-volume centers (24.2% vs 28.8%; P = .011). One-year survival rate (81.6% vs 76.1%; P = .001) and median survival (4.93 years vs 4.00 years; P = .018) were greater at high-volume centers. Multivariable analysis identified low-volume center status as an independent predictor of higher mortality (hazard ratio, 1.28; 95% confidence interval, 1.10-1.50; P = .002). Conclusions High-volume centers were associated with superior survival and improved perioperative outcomes following LVAD explant-OHT.","journal":"JTCVS Open","year":2025,"id":581923,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7908,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":917569,"name":"Clayton J. Rust","orcid":"0000-0001-5929-0733","position":1,"is_corresponding":false},{"id":1123268,"name":"Reshma Kodimerla","orcid":"0000-0003-1442-7489","position":2,"is_corresponding":false},{"id":1493441,"name":"Sally El Sammak","orcid":"0000-0002-4791-4729","position":3,"is_corresponding":false},{"id":1493442,"name":"Konstantinos S. Mylonas","orcid":"0000-0002-2356-6694","position":4,"is_corresponding":false},{"id":1491259,"name":"Humza Naqvi","orcid":"0009-0004-5592-8700","position":5,"is_corresponding":false},{"id":1471303,"name":"Supreet S. Randhawa","orcid":null,"position":6,"is_corresponding":false},{"id":1419957,"name":"Ailin Tang","orcid":"0009-0007-8715-1678","position":7,"is_corresponding":false},{"id":642388,"name":"Michael E. Halkos","orcid":"0000-0001-9191-7743","position":8,"is_corresponding":false},{"id":284415,"name":"Muath Bishawi","orcid":"0000-0002-8906-3600","position":9,"is_corresponding":false},{"id":107525,"name":"Mani A. Daneshmand","orcid":"0000-0002-0191-9911","position":10,"is_corresponding":false},{"id":859071,"name":"Joshua L. Chan","orcid":"0000-0001-7220-561X","position":11,"is_corresponding":false},{"id":1266833,"name":"Catherine McGeoch","orcid":"0000-0002-3391-2183","position":0,"is_corresponding":true}],"reference_count":31,"raw_metadata":null,"created_at":"2026-07-19T02:58:51.328454Z","pmid":"41960050","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}