Clinical outcomes of temporary mechanical circulatory support as a direct bridge to heart transplantation: a nationwide Spanish registry

Barge-Caballero, E. ; Almenar-Bonet, L. ; Gonzalez-Vilchez, F. ; Lambert-Rodríguez, J.L. ; González-Costello, J. ; Segovia-Cubero, J. ; Castel-Lavilla, M.A. ; Delgado-Jiménez, J. ; Garrido-Bravo, I.P. ; Rangel-Sousa, D. ; Martínez-Sellés, M. ; De la Fuente-Galan, L. ; Rábago-Juan-Aracil, G. ; Sanz-Julve, M. (Universidad de Zaragoza) ; Hervás-Sotomayor, D. ; Mirabet-Pérez, S. ; Muñiz, J. ; Crespo-Leiro, M.G.

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 13.1 ± 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.
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.

Idioma: Inglés

DOI: 10.1002/ejhf.956

Año: 2018

Publicado en: European Journal of Heart Failure 20, 1 (2018), 178-186
ISSN: 1388-9842

Factor impacto JCR: 13.965 (2018)

Categ. JCR: CARDIAC & CARDIOVASCULAR SYSTEMS rank: 6 / 136 = 0.044 (2018) - Q1 - T1

Factor impacto SCIMAGO: 5.537 - Cardiology and Cardiovascular Medicine (Q1)

Tipo y forma: Article (Published version)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)