Clinical outcomes of temporary mechanical circulatory support as a direct bridge to heart transplantation: a nationwide Spanish registry. (26th September 2017)

• Record Type: Journal Article
• Authors: Barge‐Caballero, Eduardo; Almenar‐Bonet, Luis; Gonzalez‐Vilchez, Francisco; Lambert‐Rodríguez, José L.; González‐Costello, José; Segovia‐Cubero, Javier; Castel‐Lavilla, María A.; Delgado‐Jiménez, Juan; Garrido‐Bravo, Iris P.; Rangel‐Sousa, Diego; Martínez‐Sellés, Manuel; De la Fuente‐Galan, Luis; Rábago‐Juan‐Aracil, Gregorio; Sanz‐Julve, Marisa; Hervás‐Sotomayor, Daniela; Mirabet‐Pérez, Sonia; Muñiz, Javier; Crespo‐Leiro, Maria G.
• Is Part Of: European journal of heart failure. Volume 20:Number 1(2018)
• Page Start: 178
• Page End: 186
• Publication Date: 2017-09-26
• Subjects: Ventricular assist device -- Mechanical circulatory support -- Heart transplantation -- Extracorporeal membrane oxygenation; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.956
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract : 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.