Detalle Publicación

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

Autores: Barge-Caballero, E. (Autor de correspondencia); Almenar-Bonet, L.; Gonzalez-Vilchez, F. ; Lambert-Rodriguez, J. L.; Gonzalez-Costello, J. ; Segovia-Cubero, J. ; Castel-Lavilla, M. A.; Delgado-Jimenez, J. ; Garrido-Bravo, I. P.; Rangel-Sousa, D.; Martinez-Selles, M.; De la Fuente-Galan, L.; Rabago Juan Aracil, Gregorio; Sanz-Julve, M.; Hervas-Sotomayor, D.; Mirabet-Perez, S. ; Muniz, J.; Crespo-Leiro, M. G.
ISSN: 1388-9842
Volumen: 20
Número: 1
Páginas: 178 - 186
Fecha de publicación: 2018
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 13.112.6days. 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.