Clinical outcomes of temporary mechanical circulatory support as a direct bridge to heart transplantation: a nationwide Spanish registry
Por:
Barge-Caballero, E, Almenar-Bonet, L, Gonzalez-Vilchez, F, Lambert-Rodriguez, JL, Gonzalez-Costello, J, Segovia-Cubero, J, Castel-Lavilla, MA, Delgado-Jimenez, J, Garrido-Bravo, IP, Rangel-Sousa, D, Martinez-Selles, M, De la Fuente-Galan, L, Rabago-Juan-Aracil, G, Sanz-Julve, M, Hervas-Sotomayor, D, Mirabet-Perez, S, Muniz, J, Crespo-Leiro, MG
Publicada:
1 ene 2018
Resumen:
Background In Spain, listing for high-urgent heart transplantation is allowed for critically ill candidates not weanable from temporary mechanical circulatory support (T-MCS). We sought to analyse the clinical outcomes of this strategy.
Methods and results We conducted a case-by-case, retrospective review of clinical records of 291 adult patients listed for high-urgent heart transplantation under temporary devices from 2010 to 2015 in 16 Spanish institutions. Survival after listing and adverse clinical events were studied. At the time of listing, 169 (58%) patients were supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO), 70 (24%) on temporary left ventricular assist devices (T-LVAD) and 52 (18%) on temporary biventricular assist devices (T-BiVAD). Seven patients transitioned from VA-ECMO to temporary ventricular assist devices while on the waiting list. Mean time on T-MCS was 13.112.6days. Mean time from listing to transplantation was 7.6 +/- 8.5 days. Overall, 230 (79%) patients were transplanted and 54 (18.6%) died during MCS. In-hospital postoperative mortality after transplantation was 33.3%, 11.9% and 26.2% for patients bridged on VA-ECMO, T-LVAD and T-BiVAD, respectively (P = 0.008). Overall survival from listing to hospital discharge was 54.4%, 78.6% and 55.8%, respectively (P = 0.002). T-LVAD support was independently associated with a lower risk of death over the first year after listing (hazard ratio 0.52, 95% confidence interval 0.30-0.92). Patients treated with VA-ECMO showed the highest incidence rate of adverse clinical events associated with T-MCS.
Conclusion Temporary devices may be used to bridge critically ill candidates directly to heart transplantation in a setting of short waiting list times, as is the case of Spain. In our series, bridging with T-LVAD was associated with more favourable outcomes than bridging with T-BiVAD or VA-ECMO.
Filiaciones:
Barge-Caballero, E:
Complejo Hosp Univ A Coruna, La Coruna, Spain
Almenar-Bonet, L:
Hosp Univ & Politecn La Fe, Valencia, Spain
Gonzalez-Vilchez, F:
Hosp Univ Marques de Valdecilla, Santander, Spain
Lambert-Rodriguez, JL:
Hosp Univ Cent Asturias, Oviedo, Spain
Gonzalez-Costello, J:
Hosp Univ Bellvitge, Lhospitalet De Llobregat, Spain
Segovia-Cubero, J:
Hosp Univ Puerta de Hierro, Madrid, Spain
Castel-Lavilla, MA:
Hosp Clin Barcelona, Barcelona, Spain
Delgado-Jimenez, J:
Hosp Univ Doce Octubre, Madrid, Spain
Garrido-Bravo, IP:
Hosp Univ Virgen de la Arrixaca, Murcia, Spain
Rangel-Sousa, D:
Hosp Univ Virgen del Rocio, Seville, Spain
Martinez-Selles, M:
Univ Complutense, Hosp Univ Gregorio Maranon, Univ Europea, Madrid, Spain
De la Fuente-Galan, L:
Hosp Clin Univ, Valladolid, Spain
Rabago-Juan-Aracil, G:
Clin Univ Navarra, Pamplona, Spain
Sanz-Julve, M:
Hosp Univ Miguel Servet, Zaragoza, Spain
Hervas-Sotomayor, D:
Hosp Univ Reina Sofia, Cordoba, Spain
Mirabet-Perez, S:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Muniz, J:
Univ A Coruna UDC, Inst Univ Ciencias Salud, La Coruna, Spain
Crespo-Leiro, MG:
Complejo Hosp Univ A Coruna, La Coruna, Spain
Bronze, Green Published
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