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Clinical outcomes of temporary mechanical circulatory support as a direct bridge to heart transplantation: a nationwide Spanish registry.
- Source :
-
European Journal of Heart Failure . Jan2018, Vol. 20 Issue 1, p178-186. 9p. 1 Diagram, 5 Charts, 2 Graphs. - Publication Year :
- 2018
-
Abstract
- <bold>Background: </bold>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.<bold>Methods and Results: </bold>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 13.1 ± 12.6 days. 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.<bold>Conclusion: </bold>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. [ABSTRACT FROM AUTHOR]
- Subjects :
- *HEART transplantation
*EXTRACORPOREAL membrane oxygenation
*HEART assist devices
*CRITICALLY ill
*MEDICAL records
*HEALTH outcome assessment
*COMPARATIVE studies
*HEART failure
*RESEARCH methodology
*MEDICAL cooperation
*RESEARCH
*SURVIVAL
*TIME
*EVALUATION research
*ACQUISITION of data
*RETROSPECTIVE studies
*HOSPITAL mortality
Subjects
Details
- Language :
- English
- ISSN :
- 13889842
- Volume :
- 20
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- European Journal of Heart Failure
- Publication Type :
- Academic Journal
- Accession number :
- 127746065
- Full Text :
- https://doi.org/10.1002/ejhf.956