Valvular heart failure represents a distinct but transplantable phenotype with a 23% higher rate of waitlist death/too sick to transplant compared to non-VHF, but post-transplant survival is comparable to non-VHF recipients, and allocation framework revisions attenuated the waitlist mortality difference.
VHF patients had a 23% higher rate of waitlist death or becoming too sick to transplant compared to non-VHF patients.
Post-transplant survival was not significantly different between VHF and non-VHF recipients.
VHF recipients had a distinct demographic and clinical phenotype compared to non-VHF recipients at the time of listing.
VHF recipients had higher ECMO use and lower VAD use at the time of listing compared to non-VHF recipients.
Post-2018 allocation era changes attenuated the waitlist mortality difference between VHF and non-VHF patients.
The study used a retrospective cohort design drawing from the UNOS thoracic transplant database.
This research suggests that patients with heart failure caused by valvular heart disease (problems with the heart's valves) represent a distinct group among those awaiting heart transplants. Compared to patients with other causes of heart failure, those with valvular heart failure were older, more often female, more likely to have had prior heart surgery, and had more strain on their lung blood vessels. They were also more likely to be on a heart-lung bypass machine (ECMO) and less likely to have a ventricular assist device (VAD) while waiting for a transplant. Importantly, valvular heart failure patients faced a 23% higher risk of dying or becoming too sick to receive a transplant while on the waitlist, but once they received a transplant, their survival was just as good as patients with other types of heart failure. This research also suggests that changes made to the heart transplant allocation system in 2018 helped reduce the gap in waitlist mortality between valvular and non-valvular heart failure patients. The factors that predicted worse outcomes after transplant were related to individual patient characteristics rather than the valvular diagnosis itself, pointing to the importance of referring these patients early and optimizing their health before transplant. The practical implication of these findings is that valvular heart failure should not be seen as a barrier to heart transplantation — outcomes after transplant are comparable to other heart failure types. However, the higher risk of dying or deteriorating while waiting for a transplant highlights the need for early identification and referral of these patients, so they can be listed and managed before their condition becomes too severe for transplantation.
Kelley D, Kathawate V, Ho J, Belec A, Tashima T, Ueno K, et al.. (2026). Valvular heart failure is a distinct heart transplant phenotype with comparable adjusted survival to other heart failure etiologies.. International journal of cardiology. https://doi.org/10.1016/j.ijcard.2026.134747