**4. Ventricular Assist Device (VAD) for bridging to heart transplantation**

The provision of Ventricular Assist Devices (VADs) as a bridge to heart transplantation has been available at Papworth Hospital NHS Foundation Trust, the Royal Brompton and Harefield NHS Trust and The Newcastle upon Tyne Hospitals NHS Foundation Trust since 2002, and more recently at the other cardiothoracic transplant centres in the UK. Data on implantation, explantation, death and ongoing survival are recorded by NHSBT as part of the cardiothoracic transplant database.

NHSBT provide monthly reports to the National Specialised Commissioning Team on VAD activity and outcomes for each of the national centres. These data are shared with all centres at twice yearly meetings of the National VAD Forum convened and chaired by the National Specialised Commissioning Team and where representatives from each of the national cardiothoracic transplant centres are present. This allows an open and transparent forum for shared learning and has been the vehicle for developing the commissioning policy for expansion of the VAD service within the national cardiothoracic transplant programme.

Additionally, the UK Cardiothoracic Transplant Audit publishes the 30-day, 90-day, 1-year, 2-year and 3-year mortality for those individuals receiving short-term and long-term VADs as a bridge to transplantation, and highlights the survival experience with these devices. The audit also presents data on those VADs used to mechanically support a recently transplanted heart where primary graft failure is experienced, once again informing the development of the service and supporting quality improvement. These data are reviewed at the twice yearly National VAD Forum meetings.

A recent innovation is development of a much more comprehensive and bespoke VAD Database overseen by NHSBT that will allow much greater understanding of the experience with long-term VADs and provide a rich repository for research. The three early providers of long-term VADs (Papworth Hospital NHS Foundation Trust, the Royal Brompton and Harefield NHS Trust and The Newcastle upon Tyne Hospitals NHS Foundation Trust) are completing the population of the database with all historical cases receiving a long-term VAD, whilst all current providers are contributing to data entry on all prospective cases receiving a VAD.

This will provide anonymised data on the entire national cohort of patients receiving VADs and is expected to enable research to help further develop the evidence base in this rapidly changing technology.
