Temporal trends in the use and outcomes of temporary mechanical circulatory support as a bridge to cardiac transplantation in Spain. Final report of the ASIS-TC study
Por:
Barge-Caballero E., González-Vílchez F., Almenar-Bonet L., Carmena M.D.G.-C., González-Costello J., Gómez-Bueno M., Castel-Lavilla M.Á., Lambert-Rodríguez J.L., Martínez-Sellés M., Mirabet-Pérez S., la Fuente-Galán L.D., Hervás-Sotomayor D., Rangel-Sousa D., Garrido-Bravo I.P., Blasco-Peiró T., Juan-Aracil G.R., Muñiz J., Crespo-Leiro M.G.
Publicada:
1 abr 2023
Ahead of Print:
1 ene 2022
Resumen:
Background: We aimed to describe recent trends in the use and outcomes of temporary mechanical circulatory support (MCS) as a bridge to heart transplantation (HTx) in Spain. Methods: Retrospective case-by-case analysis of 1,036 patients listed for emergency HTx while on temporary MCS in 16 Spanish institutions from January 1st, 2010 to December 31st, 2020. Patients were classified in 3 eras according to changes in donor allocation criteria (Era 1: January 2010/May 2014; Era 2: June 2014/May 2017; Era 3: June 2017/December 2020). Results: Over time, the proportion of candidates listed with intra-aortic balloon pumps decreased (Era 1 = 55.9%, Era 2 = 32%, Era 3 = 0.9%; p < 0.001), while the proportion of candidates listed with surgical continuous-flow temporary VADs (Era 1 = 10.6%, Era 2 = 32%, Era 3 = 49.1%; p < 0.001) and percutaneous VADs (Era 1 = 0.3%, Era 2 = 6.3%; Era 3 = 17.2%; p < 0.001) increased. Rates of HTx increased from Era 1 (79.4%) to Era 2 (87.8%), and Era 3 (87%) (p = 0.004), while rates of death before HTx decreased (Era 1 = 17.7%; Era 2 = 11%, Era 3 = 12.4%; p = 0.037) Median time from listing to HTx increased in patients supported with intra-aortic balloon pumps (Era 1 = 8 days, Era 2 = 15 days; p < 0.001) but remained stable in other candidates (Era 1 = 6 days; Era 2 = 5 days; Era 3 = 6 days; p = 0.134). One-year post-transplant survival was 71.4% in Era 1, 79.3% in Era 2, and 76.5% in Era 3 (p = 0.112). Preoperative bridging with ECMO was associated with increased 1-year post-transplant mortality (adjusted HR=1.71; 95% CI 1.15-2.53; p = 0.008). Conclusions: During the period 2010 to 2020, successive changes in the Spanish organ allocation protocol were followed by a significant increase of the rate of HTx and a significant reduction of waiting list mortality in candidates supported with temporary MCS. One-year post-transplant survival rates remained acceptable. © 2022 International Society for Heart and Lung Transplantation
Filiaciones:
Barge-Caballero E.:
Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
González-Vílchez F.:
Hospital Universitario Marqués de Valdecilla, Santander, Spain
Almenar-Bonet L.:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
Hospital Universitario Politécnico La Fe, Valencia, Spain
Carmena M.D.G.-C.:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
Hospital Universitario Doce de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
González-Costello J.:
Hospital Universitari de Bellvitge, Institut d´investigació Biomédica de Bellvitge (IDIBELL), L´Hospitalet de Llobregat (Barcelona), Spain
Gómez-Bueno M.:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
Hospital Universitario Puerta de Hierro, Majadahonda (Madrid), Spain
Castel-Lavilla M.Á.:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
Hospital Clínic de Barcelona, Barcelona, Spain
Lambert-Rodríguez J.L.:
Hospital Universitario Central de Asturias, Oviedo, Spain
Martínez-Sellés M.:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
Hospital General Universitario Gregorio Marañón, Madrid, Spain
Mirabet-Pérez S.:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
Hospital Santa Creu i Sant Pau, Barcelona, Spain
la Fuente-Galán L.D.:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Hervás-Sotomayor D.:
Hospital Universitario Reina Sofía, Córdoba, Spain
Rangel-Sousa D.:
Hospital Universitario Virgen del Rocío, Sevilla, Spain
Garrido-Bravo I.P.:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
Blasco-Peiró T.:
Hospital Universitario Miguel Servet, Zaragoza, Spain
Juan-Aracil G.R.:
Hospital Clínica Universidad de Navarra, Pamplona, Spain
Muñiz J.:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
Universidade de A Coruña, A Coruña, Spain
Crespo-Leiro M.G.:
Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
Universidade de A Coruña, A Coruña, Spain
Bronze, All Open Access; Bronze
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