RT Journal Article
T1 Clinical outcomes of temporary mechanical circulatory support as a direct bridge to heart transplantation: a nationwide Spanish registry.
A1 Barge-Caballero, Eduardo
A1 Almenar-Bonet, Luis
A1 Gonzalez-Vilchez, Francisco
A1 Lambert-Rodríguez, José L
A1 González-Costello, José
A1 Segovia-Cubero, Javier
A1 Castel-Lavilla, María A
A1 Delgado-Jiménez, Juan
A1 Garrido-Bravo, Iris P
A1 Rangel-Sousa, Diego
A1 Martínez-Sellés, Manuel
A1 De la Fuente-Galan, Luis
A1 Rábago-Juan-Aracil, Gregorio
A1 Sanz-Julve, Marisa
A1 Hervás-Sotomayor, Daniela
A1 Mirabet-Pérez, Sonia
A1 Muñiz, Javier
A1 Crespo-Leiro, Maria G
K1 Extracorporeal membrane oxygenation
K1 Heart transplantation
K1 Mechanical circulatory support
K1 Ventricular assist device
AB 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. 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. 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.
YR 2017
FD 2017-09-26
LK http://hdl.handle.net/10668/11612
UL http://hdl.handle.net/10668/11612
LA en
DS RISalud
RD Apr 6, 2025