Back to Search
Start Over
Comparison of ECMO Patients Bridged to LVAD vs Bridged to Transplantation
- Source :
- The Journal of Heart and Lung Transplantation. 38:S32
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Purpose With the implementation of the new heart allocation system, the goal of our study was to compare the outcomes of patients supported with extracorporeal membrane oxygenation who were bridged to transplantation versus bridged to a left ventricular assist device prior to transplantation. Methods The UNOS database was queried for all adult patients (age >=18) who required support with ECMO at the time of listing or while on the waitlist for a heart from 2001-2018. Patients who successfully underwent orthotopic heart transplantation were stratified into those bridged immediately to transplantation from ECMO and those bridged to an LVAD prior to transplantation. Demographics, one year survival, postoperative stroke, postoperative renal failure requiring dialysis, episodes of rejection, and graft failure were compared. Results A total of 186 patients meeting criteria were identified. 117 patients were bridged from ECMO directly to transplantation, and 69 patients were successfully bridged from ECMO to either a Heartmate II or Heartware device prior to transplantation. Kaplan-Meier survival estimates and log-rank test found a statistically significant difference in one year survival between patients who were bridge from ECMO to transplantation compared to those who were bridged to an LVAD prior to subsequent transplantation (p=0.0004, Figure 1). Incidence of new postoperative renal failure requiring dialysis (20.4% vs 1.5%), stroke (10.4% vs 1.5%), and postoperative graft failure (14.0% vs 2.9%) was higher and episodes of rejection requiring treatment (12.6% vs 18.8%) were lower in the patients bridged directly from ECMO to transplantation compared to patients bridged to an LVAD prior to transplantation. Conclusion Our study suggests that bridging ECMO patients to an LVAD prior to transplantation will result in improved one year survival compared to patients bridged to immediate transplantation. With the new heart allocation system, continued evaluation of outcomes is required to inform management strategies.
- Subjects :
- Pulmonary and Respiratory Medicine
Heart transplantation
Transplantation
medicine.medical_specialty
Graft failure
Adult patients
Heartmate ii
business.industry
medicine.medical_treatment
Significant difference
030204 cardiovascular system & hematology
Surgery
03 medical and health sciences
surgical procedures, operative
0302 clinical medicine
Ventricular assist device
medicine
Extracorporeal membrane oxygenation
030212 general & internal medicine
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 10532498
- Volume :
- 38
- Database :
- OpenAIRE
- Journal :
- The Journal of Heart and Lung Transplantation
- Accession number :
- edsair.doi...........091ed20be6a04dd4867d504a381a18be