Venoarterial extracorporeal membrane oxygenation with or without simultaneous intra-aortic balloon pump support as a direct bridge to heart transplantation: results from a nationwide Spanish registry
Por:
Barge-Caballero, G, Castel-Lavilla, MA, Almenar-Bonet, L, Garrido-Bravo, IP, Delgado, JF, Rangel-Sousa, D, Gonzalez-Costello, J, Segovia-Cubero, J, Farrero-Torres, M, Lambert-Rodriguez, JL, Crespo-Leiro, MG, Hervas-Sotomayor, D, Portoles-Ocampo, A, Martinez-Selles, M, De La Fuente-Galan, L, Rabago-Juan-Aracil, G, Gonzalez-Vilchez, F, Mirabet-Perez, S, Muniz, J, Barge-Caballero, E
Publicada:
1 nov 2019
Resumen:
OBJECTIVES: To investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT).
METHODS: We studied 169 patients who were listed for urgent HT under VA-ECMO support at 16 Spanish institutions from 2010 to 2015. The clinical outcomes of patients under simultaneous IABP support (n=73) were compared to a control group of patients without IABP support (n=96).
RESULTS: There were no statistically significant differences between the IABP and control groups with regard to the cumulative rates of transplantation (71.2% vs 81.2%, P=0.17), death during VA-ECMO support (20.6% vs 14.6%, P=0.31), transition to a different mechanical circulatory support device (5.5% vs 5.2%, P=0.94) or weaning from VA-ECMO support due to recovery (2.7% vs 0%, P=0.10). There was a higher incidence of bleeding events in the IABP group (45.2% vs 25%, P=0.006; adjusted odds ratio 2.18, 95% confidence interval 1.02-4.67). In-hospital postoperative mortality after HT was 34.6% in the IABP group and 32.5% in the control group (P=0.80). One-year survival after listing for urgent HT was 53.3% in the IABP group and 52.2% in the control group (log rank P=0.75). Multivariate adjustment for potential confounders did not change this result (adjusted hazard ratio 0.94, 95% confidence interval 0.56-1.58).
CONCLUSIONS: In our study, simultaneous IABP therapy in transplant candidates under VA-ECMO support did not significantly reduce morbidity or mortality.
Filiaciones:
Barge-Caballero, G:
CHUAC, Inst Invest Biomed A Coruna INIBIC, La Coruna, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Castel-Lavilla, MA:
Hosp Clin Barcelona, Barcelona, Spain
Almenar-Bonet, L:
Hosp Univ & Politecn La Fe, Valencia, Spain
Garrido-Bravo, IP:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Hosp Univ Virgen Arrixaca, Murcia, Spain
Delgado, JF:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Univ Complutense Madrid, Fac Med, Inst Invest I 12, Hosp Univ Doce Octubre, Madrid, Spain
Rangel-Sousa, D:
Hosp Univ Virgen Rocio, Seville, Spain
Gonzalez-Costello, J:
Hosp Univ Bellvitge, Lhospitalet De Llobregat, Spain
Segovia-Cubero, J:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Hosp Univ Puerta Hierro, Majadahonda, Spain
Farrero-Torres, M:
Hosp Clin Barcelona, Barcelona, Spain
Lambert-Rodriguez, JL:
Hosp Univ Cent Asturias, Oviedo, Spain
Univ Catolica San Antonio, Murcia, Spain
Crespo-Leiro, MG:
CHUAC, Inst Invest Biomed A Coruna INIBIC, La Coruna, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Hervas-Sotomayor, D:
Hosp Univ Reina Sofia, Cordoba, Spain
Portoles-Ocampo, A:
Hosp Univ Miguel Servet, Zaragoza, Spain
Martinez-Selles, M:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Univ Complutense, Univ Europea, Hosp Gen Univ Gregorio Maranon, Madrid, Spain
De La Fuente-Galan, L:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Hosp Clin Univ, Valladolid, Spain
Rabago-Juan-Aracil, G:
Clin Univ Navarra, Pamplona, Spain
Gonzalez-Vilchez, F:
Hosp Univ Marques Valdecilla, Santander, Spain
Mirabet-Perez, S:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Muniz, J:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Univ A Coruna UDC, INIBIC, Inst Univ Ciencias Salud, La Coruna, Spain
Barge-Caballero, E:
CHUAC, Inst Invest Biomed A Coruna INIBIC, La Coruna, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
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