**Introduction/Hypothesis**
Sarcoidosis is an infiltrative granulomatous disease that affects various organ systems in an unpredictable manner. In cardiac sarcoidosis, granulomas can form in the myocardium, pericardium, and endocardium, although the most typical presentation is myocardial. Cardiac sarcoidosis can have devastating effects including end stage heart failure.  Several studies have shown that patients with cardiac sarcoidosis who undergo LVAD implant or transplant have similar outcomes as patients without cardiac sarcoidosis, although these studies do not specify whether patients were diagnosed with cardiac sarcoidosis before or after LVAD implantation or transplant.

**Methods**
We retrospectively identified 232 consecutive patients meeting diagnostic criteria for cardiac sarcoidosis. Of these patients, 54 were diagnosed by pathologic confirmation of cardiac sarcoidosis—10 after evaluation of the apical core (LVAD implant) or explanted heart (transplant). We compared clinical characteristics at initial evaluation and outcomes for these 10 patients with those of 10 patients with known cardiac sarcoidosis before LVAD implant/transplant.

**Results**
All 10 patients diagnosed at implant or transplant had at least 1 year of follow-up data (median follow-up, 4.5 years). Six (60%) of the patients underwent LVAD implantation, and 4 (40%) had heart transplants. Of the 6 patients who underwent LVAD implantation, 3 ultimately had heart transplants. The mean (SD) age at LVAD implant/transplant was 52 (9) years; 7 patients (70%) were men; 9 (90%) were non-Hispanic white; and 1 (10%) was African-American. At the initial evaluation, 3 (30%) patients had New York Heart Association (NYHA) class II heart failure symptoms (progressing to NYHA class IV), 4 (40%) had NYHA class IIIB symptoms, and 3 (30%) had NYHA class IV symptoms. Four patients died during follow-up; however, no survival difference was found for the 10 patients diagnosed incidentally and the group with a previous diagnosis or institutional LVAD/transplant cohorts.

**Conclusion**
Patients with advanced heart failure from cardiac sarcoidosis who require cardiac support with an LVAD or who undergo cardiac transplantation comprise a potentially high-risk population, given the frequent multiorgan involvement of systemic sarcoidosis. Nevertheless, in this study, patients with cardiac sarcoidosis had similar survival rates to those of our entire transplant or LVAD cohorts. These results were the same for patients who had known cardiac sarcoidosis or who were diagnosed incidentally at the time of LVAD implant/transplant and suggest that a confirmed or suspected diagnosis of cardiac sarcoidosis should not be a limiting factor for proceeding with LVAD implantation or cardiac transplant when other established criteria are met.



Natural History of Patients Diagnosed With Cardiac Sarcoidosis at Left Ventricular Assist Device Implantation or Cardiac Transplantation