Detalle Publicación

Venoarterial extracorporeal membrane oxygenation with or without simultaneous intra-aortic balloon pump support as a direct bridge to heart transplantation: results from a nationwide Spanish registry

Autores: Barge-Caballero, G. (Autor de correspondencia); Castel-Lavilla, M. A.; Almenar-Bonet, L.; Garrido-Bravo, I. P.; Delgado, J. F.; Rangel-Sousa, D.; Gonzalez-Costello, J.; Segovia-Cubero, J.; Farrero-Torres, M.; Lambert-Rodriguez, J. L.; Crespo-Leiro, M. G.; Hervas-Sotomayor, D.; Portoles-Ocampo, A.; Martinez-Selles, M.; De La Fuente-Galan, L.; Rabago Juan Aracil, Gregorio; Gonzalez-Vilchez, F.; Mirabet-Perez, S.; Muniz, J.; Barge-Caballero, E.
ISSN: 1569-9293
Volumen: 29
Número: 5
Páginas: 670 - 677
Fecha de publicación: 2019
OBJECTIVES: To investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT). METHODS: We studied 169 patients who were listed for urgent HT under VA-ECMO support at 16 Spanish institutions from 2010 to 2015. The clinical outcomes of patients under simultaneous IABP support (n=73) were compared to a control group of patients without IABP support (n=96). RESULTS: There were no statistically significant differences between the IABP and control groups with regard to the cumulative rates of transplantation (71.2% vs 81.2%, P=0.17), death during VA-ECMO support (20.6% vs 14.6%, P=0.31), transition to a different mechanical circulatory support device (5.5% vs 5.2%, P=0.94) or weaning from VA-ECMO support due to recovery (2.7% vs 0%, P=0.10). There was a higher incidence of bleeding events in the IABP group (45.2% vs 25%, P=0.006; adjusted odds ratio 2.18, 95% confidence interval 1.02-4.67). In-hospital postoperative mortality after HT was 34.6% in the IABP group and 32.5% in the control group (P=0.80). One-year survival after listing for urgent HT was 53.3% in the IABP group and 52.2% in the control group (log rank P=0.75). Multivariate adjustment for potential confounders did not change this result (adjusted hazard ratio 0.94, 95% confidence interval 0.56-1.58). CONCLUSIONS: In our study, simultaneous IABP therapy in transplant candidates under VA-ECMO support did not significantly reduce morbidity or mortality.