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Hong Y, Nasim U, Iyanna N, Dorken-Gallastegi A, Keebler ME, Horn ET, Hickey GW, Kaczorowski DJ. Durable left ventricular assist device in donation after circulatory death heart transplantation. J Heart Lung Transplant 2025:S1053-2498(25)00059-2. [PMID: 39947501 DOI: 10.1016/j.healun.2025.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 01/17/2025] [Accepted: 01/27/2025] [Indexed: 02/23/2025] Open
Abstract
BACKGROUND This study evaluates outcomes following donation after circulatory death (DCD) heart transplantation in recipients with a durable left ventricular assist device (LVAD). METHODS The UNOS registry was queried to analyze adult recipients of isolated DCD heart transplantation between 1/1/2019-3/31/2023. The recipients were stratified by durable LVAD use as a bridge to transplantation. The primary outcome was 1-year post-transplant survival. Sub-group analyses were conducted to evaluate the effects of transplant status, device type, and donor type on 1-year survival. RESULTS A total of 703 recipients were included, of which 219 (31.2%) recipients were bridged with a durable LVAD. The recipients of DCD hearts with durable LVADs had significantly lower 1-year post-transplant survival compared to those without durable LVADs (88.4% vs. 93.6%, p=0.017). Among the recipients bridged with durable LVADs, status 4 recipients had significantly improved 1-year survival compared to statuses 2 and 3 recipients, similar to those without durable LVADs. Furthermore, the recipients with HeartMate II and HeartMate 3 had improved survival compared to those with the HeartWare HVAD, similar to those without durable LVADs. Lastly, the DCD and DBD recipients with durable LVADs had comparable 1-year survival (88.4% vs. 89.0%, p=0.763). CONCLUSIONS Recipients of DCD hearts bridged to transplantation with a durable LVAD exhibit reduced early post-transplant survival compared to those without a durable LVAD. However, clinical acuity and device type significantly influence post-transplant outcomes in this vulnerable population. Despite this, candidates with a durable LVAD can safely undergo DCD heart transplantation, achieving early post-transplant survival comparable to those of DBD heart transplantation.
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Affiliation(s)
- Yeahwa Hong
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Umar Nasim
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA
| | - Nidhi Iyanna
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Mary E Keebler
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Edward T Horn
- Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Gavin W Hickey
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David J Kaczorowski
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
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2
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Lakhani HA, Lizarzaburo Penafiel LS, Fakhoury M, Seide M, Duran S PX, See JW, Dhillon DK, Shah S, Khan AM, Nimmagadda M, Susmitha T, Rai M. Heart Transplantation and Left Ventricular Assist Devices: Long-Term Prognosis and Effects on Mental Health. Cureus 2024; 16:e68691. [PMID: 39371854 PMCID: PMC11452842 DOI: 10.7759/cureus.68691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 10/08/2024] Open
Abstract
Heart transplantation and left ventricular assist devices (LVADs) have emerged as crucial interventions for end-stage heart failure, dramatically improving patient outcomes. This narrative review examines their historical context, indications, procedures, and outcomes, as well as their impact on long-term survival, quality of life, functional status, and mental health. While heart transplantation remains the optimal treatment, donor scarcity limits its application. LVADs have become a viable alternative, either as a bridge to transplantation or as destination therapy. Both interventions demonstrate similar long-term survival rates and significant improvements in health-related quality of life and functional status. However, they present distinct long-term management challenges, including immunosuppression needs for transplant recipients and device-related issues for LVAD patients. Mental health effects are considerable, necessitating psychological support and adaptive coping strategies. Complications such as infection, bleeding, and thrombosis remain concerns for both interventions. Patient selection criteria, technological advancements, and long-term management strategies are critical factors in optimizing outcomes. Future research should focus on device miniaturization, enhanced biocompatibility, and less invasive insertion techniques to further advance these therapies and improve patient care in end-stage heart failure.
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Affiliation(s)
| | | | - Marc Fakhoury
- Cardiology, Saint Joseph University of Beirut, Beirut, LBN
| | - Melinda Seide
- Internal Medicine, St. George's University School of Medicine, St. George's, GRD
| | | | - Jia Whei See
- Internal Medicine, Universitas Sriwijaya, Kota Palembang, IDN
| | | | - Shivendra Shah
- Internal Medicine, Nepalgunj Medical College, Nepalgunj, NPL
| | | | | | | | - Manju Rai
- Biotechnology, Shri Venkateshwara University, Gajraula, IND
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3
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Shah MM, Rando H, Polanco AR, Kilic A. ECMO as a bridge to heart transplantation: Insights into stratification by heart failure etiology. JHLT OPEN 2024; 5:100097. [PMID: 40143916 PMCID: PMC11935478 DOI: 10.1016/j.jhlto.2024.100097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/28/2025]
Abstract
Background Revisions to the heart allocation criteria in 2018 motivated an increased use of extracorporeal membrane oxygenation (ECMO) as a bridge to transplantation. Studies have demonstrated inferior post-transplant outcomes in patients bridged with ECMO but do not account for underlying diagnosis. Our objective was to elucidate the differential impact of ECMO on outcomes by heart failure (HF) etiology. Methods The United Network of Organ Sharing database was queried for adults who underwent isolated heart transplantation after October 2018. Patients were stratified by ECMO utilization at the time of transplantation and then by HF etiology. After baseline statistical comparisons, survival analysis relied on Kaplan-Meier estimates and Cox proportional models. Results A total of 13,203 patients were included, of whom 761 (5.8%) were supported with ECMO. ECMO patients were younger (48 vs 54 years, p < 0.001), less likely to have diabetes (24% vs 30%, p < 0.001), smoke cigarettes (31% vs 41%, p < 0.001), or have prior cardiac surgery (29% vs 36%, p < 0.001), more likely to require dialysis (20% vs 5%, p < 0.001), and spent fewer days on the waitlist (59 vs 190, p < 0.001). After adjustment, ECMO was associated with increased mortality (hazard ratio 1.85, p < 0.001) in the full cohort. After incorporating HF etiology, this increased mortality risk persisted in all subgroups except restrictive cardiomyopathy and congenital heart disease (CHD). Conclusions Our findings illustrate that HF etiology is associated with differing outcomes when bridging with ECMO. ECMO patients with restrictive cardiomyopathy or CHD did not have increased mortality risk. With ECMO utilization increasing, these data are hypothesis-generating and serve as a basis for further studies.
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Affiliation(s)
- Manuj M. Shah
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hannah Rando
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Antonio R. Polanco
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
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4
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Hatzianastasiou S, Vlachos P, Stravopodis G, Elaiopoulos D, Koukousli A, Papaparaskevas J, Chamogeorgakis T, Papadopoulos K, Soulele T, Chilidou D, Kolovou K, Gkouziouta A, Bonios M, Adamopoulos S, Dimopoulos S. Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation. World J Transplant 2024; 14:93567. [PMID: 38947964 PMCID: PMC11212582 DOI: 10.5500/wjt.v14.i2.93567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/05/2024] [Accepted: 05/20/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Transplant recipients commonly harbor multidrug-resistant organisms (MDROs), as a result of frequent hospital admissions and increased exposure to antimicrobials and invasive procedures. AIM To investigate the impact of patient demographic and clinical characteristics on MDRO acquisition, as well as the impact of MDRO acquisition on intensive care unit (ICU) and hospital length of stay, and on ICU mortality and 1-year mortality post heart transplantation. METHODS This retrospective cohort study analyzed 98 consecutive heart transplant patients over a ten-year period (2013-2022) in a single transplantation center. Data was collected regarding MDROs commonly encountered in critical care. RESULTS Among the 98 transplanted patients (70% male), about a third (32%) acquired or already harbored MDROs upon transplantation (MDRO group), while two thirds did not (MDRO-free group). The prevalent MDROs were Acinetobacter baumannii (14%), Pseudomonas aeruginosa (12%) and Klebsiella pneumoniae (11%). Compared to MDRO-free patients, the MDRO group was characterized by higher body mass index (P = 0.002), higher rates of renal failure (P = 0.017), primary graft dysfunction (10% vs 4.5%, P = 0.001), surgical re-exploration (34% vs 14%, P = 0.017), mechanical circulatory support (47% vs 26% P = 0.037) and renal replacement therapy (28% vs 9%, P = 0.014), as well as longer extracorporeal circulation time (median 210 vs 161 min, P = 0.003). The median length of stay was longer in the MDRO group, namely ICU stay was 16 vs 9 d in the MDRO-free group (P = 0.001), and hospital stay was 38 vs 28 d (P = 0.006), while 1-year mortality was higher (28% vs 7.6%, log-rank-χ 2: 7.34). CONCLUSION Following heart transplantation, a predominance of Gram-negative MDROs was noted. MDRO acquisition was associated with higher complication rates, prolonged ICU and total hospital stay, and higher post-transplantation mortality.
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Affiliation(s)
- Sophia Hatzianastasiou
- Microbiology Department and Infection Control Office, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Paraskevas Vlachos
- Heart Transplantation Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Georgios Stravopodis
- Microbiology Department and Infection Control Office, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Dimitrios Elaiopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Afentra Koukousli
- Microbiology Department and Infection Control Office, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Josef Papaparaskevas
- Microbiology Department and Infection Control Office, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | | | - Kyrillos Papadopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Theodora Soulele
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Despoina Chilidou
- Heart Transplantation Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Kyriaki Kolovou
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Aggeliki Gkouziouta
- Heart Transplantation Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Michail Bonios
- Heart Transplantation Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | | | - Stavros Dimopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Greece
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5
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McDonald WE, Shorbaji K, Kilcoyne M, Few W, Welch B, Hashmi Z, Kilic A. Impact of institutional variables on centre performance in long-term survival after heart transplant. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae111. [PMID: 38870536 PMCID: PMC11196378 DOI: 10.1093/icvts/ivae111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/23/2024] [Accepted: 06/12/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES The gold standard metric for centre-level performance in orthotopic heart transplantation (OHT) is 1-year post-OHT survival. However, it is unclear whether centre performance at 1 year is predictive of longer-term outcomes. This study evaluated factors impacting longer-term centre-level performance in OHT. METHODS Patients who underwent OHT in the USA between 2010 and 2021 were identified using the United Network of Organ Sharing data registry. The primary outcome was 5-year survival conditional on 1-year survival following OHT. Multivariable Cox proportional hazard models assessed the impact of centre-level 1-year survival rates on 5-year survival rates. Mixed-effect models were used to evaluate between-centre variability in outcomes. RESULTS Centre-level risk-adjusted 5-year mortality conditional on 1-year survival was not associated with centre-level 1-year survival rates [hazard ratio: 0.99 (0.97-1.01, P = 0.198)]. Predictors of 5-year mortality conditional on 1-year survival included black recipient race, pre-OHT serum creatinine, diabetes and donor age. In mixed-effect modelling, there was substantial variability between centres in 5-year mortality rates conditional on 1-year survival, a finding that persisted after controlling for recipient, donor and institutional factors (P < 0.001). In a crude analysis using Kaplan-Meier, the 5-year survival conditional on 1-year survival was: low volume: 86.5%, intermediate volume: 87.5%, high volume: 86.7% (log-rank P = 0.52). These measured variables only accounted for 21.4% of the between-centre variability in 5-year mortality conditional on 1-year survival. CONCLUSIONS Centre-level risk-adjusted 1-year outcomes do not correlate with outcomes in the 1- to 5-year period following OHT. Further research is needed to determine what unmeasured centre-level factors contribute to longer-term outcomes in OHT.
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Affiliation(s)
- Weston E McDonald
- Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Khaled Shorbaji
- Division of Biology and Biomedical Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Maxwell Kilcoyne
- Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - William Few
- Department of Orthopaedic Surgery, Ochsner Clinical School, Jefferson, LA, 70121, USA
| | - Brett Welch
- Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Zubair Hashmi
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Arman Kilic
- Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA
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Załęska-Kocięcka M, Morosin M, Dutton J, Garda RF, Piotrowska K, Lees N, Aw TC, Saez DG, Doce AH. Advanced Respiratory Failure Requiring Tracheostomy-A Marker of Unfavourable Prognosis after Heart Transplantation. Diagnostics (Basel) 2024; 14:851. [PMID: 38667496 PMCID: PMC11049384 DOI: 10.3390/diagnostics14080851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Advanced respiratory failure with tracheostomy requirement is common in heart recipients. The aim of the study is to assess the tracheostomy rate after orthotopic heart transplantation and identify the subgroups of patients with the highest need for tracheostomy and these groups' association with mortality at a single centre through a retrospective analysis of 140 consecutive patients transplanted between December 2012 and July 2018. As many as 28.6% heart recipients suffered from advanced respiratory failure with a need for tracheostomy that was performed after a median time of 11.5 days post-transplant. Tracheostomy was associated with a history of stroke (OR 3.4; 95% CI) 1.32-8.86; p = 0.012), previous sternotomy (OR 2.5; 95% CI 1.18-5.32; p = 0.017), longer cardiopulmonary bypass time (OR 1.01; 95% CI 1.00-1.01; p = 0.007) as well as primary graft failure (OR 6.79; 95% CI2.93-15.71; p < 0.001), need of renal replacement therapy (OR 19.2; 95% 2.53-146; p = 0.004) and daily mean SOFA score up to 72 h (OR 1.50; 95% 1.23-1.71; p < 0.01). One-year mortality was significantly higher in patients requiring a tracheostomy vs. those not requiring one during their hospital stay (50% vs. 16%, p < 0.001). The need for tracheostomy in heart transplant recipients was 30% in our study. Advanced respiratory failure was associated with over 3-fold greater 1-year mortality. Thus, tracheostomy placement may be regarded as a marker of unfavourable prognosis.
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Affiliation(s)
- Marta Załęska-Kocięcka
- Department of Mechanical Circulatory Support and Transplantation, National Institute of Cardiology, 04-628 Warsaw, Poland
- Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK; (J.D.); (R.F.G.); (N.L.); (T.-C.A.); (A.H.D.)
| | - Marco Morosin
- Department of Anaesthesia and Critical Care, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6PY, UK;
| | - Jonathan Dutton
- Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK; (J.D.); (R.F.G.); (N.L.); (T.-C.A.); (A.H.D.)
| | - Rita Fernandez Garda
- Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK; (J.D.); (R.F.G.); (N.L.); (T.-C.A.); (A.H.D.)
| | - Katarzyna Piotrowska
- Department of Quantitative Methods and Information Technology, Kozminsky University, 03-301 Warsaw, Poland;
| | - Nicholas Lees
- Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK; (J.D.); (R.F.G.); (N.L.); (T.-C.A.); (A.H.D.)
| | - Tuan-Chen Aw
- Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK; (J.D.); (R.F.G.); (N.L.); (T.-C.A.); (A.H.D.)
| | - Diana Garcia Saez
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6PY, UK;
| | - Ana Hurtado Doce
- Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK; (J.D.); (R.F.G.); (N.L.); (T.-C.A.); (A.H.D.)
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Gelzinis TA, Ungerman E, Jayaraman AL, Bartels S, Bond JA, Hayanga HK, Patel B, Khoche S, Subramanian H, Ball R, Knight J, Choi C, Ellis S. The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2021 Part II: Cardiac Transplantation. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00339-7. [PMID: 37353423 DOI: 10.1053/j.jvca.2023.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 06/25/2023]
Abstract
This article spotlights the research highlights of this year that specifically pertain to the specialty of anesthesia for heart transplantation. This includes the research on recent developments in the selection and optimization of donors and recipients, including the use of donation after cardiorespiratory death and extended criteria donors, the use of mechanical circulatory support and nonmechanical circulatory support as bridges to transplantation, the effect of COVID-19 on heart transplantation candidates and recipients, and new advances in the perioperative management of these patients, including the use of echocardiography and postoperative outcomes, focusing on renal and cerebral outcomes.
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Affiliation(s)
| | - Elizabeth Ungerman
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Arun L Jayaraman
- Department of Anesthesiology and Perioperative Medicine, Department of Critical Care Medicine, Mayo Clinic, Pheonix, AZ
| | - Steven Bartels
- Department of Anesthesiology and Perioperative Medicine, Loyola University Medical Center, Maywood, IL
| | - Jonathan A Bond
- Division of Adult Cardiothoracic Anesthesiology, University of Kentucky, Lexington, KY
| | - Heather K Hayanga
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University, WV
| | - Bhoumesh Patel
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Swapnil Khoche
- Department of Anesthesiology, University of California, San Diego, CA
| | - Harikesh Subramanian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ryan Ball
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Joshua Knight
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Christine Choi
- Department of Anesthesiology, University of California, San Diego, CA
| | - Sarah Ellis
- Department of Anesthesiology, University of California, San Diego, CA
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Zhou AL, Etchill EW, Shou BL, Whitbread JJ, Barbur I, Giuliano KA, Kilic A. Outcomes after heart transplantation in patients who have undergone a bridge-to-bridge strategy. JTCVS OPEN 2022; 12:255-268. [PMID: 36590736 PMCID: PMC9801290 DOI: 10.1016/j.xjon.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 01/04/2023]
Abstract
Objectives We compared posttransplant outcomes between patients bridged from temporary mechanical circulatory support to durable left ventricular assist device before transplant (bridge-to-bridge [BTB] strategy) and patients bridged from temporary mechanical circulatory support directly to transplant (bridge-to-transplant [BTT] strategy). Methods We identified adult heart transplant recipients in the Organ Procurement and Transplantation Network database between 2005 and 2020 who were supported with extracorporeal membrane oxygenation, intra-aortic balloon pump, or temporary ventricular assist device as a BTB or BTT strategy. Kaplan-Meier survival analysis and Cox regressions were used to assess 1-year, 5-year, and 10-year survival. Posttransplant length of stay and complications were compared as secondary outcomes. Results In total, 201 extracorporeal membrane oxygenation (61 BTB, 140 BTT), 1385 intra-aortic balloon pump (460 BTB, 925 BTT), and 234 temporary ventricular assist device (75 BTB, 159 BTT) patients were identified. For patients supported with extracorporeal membrane oxygenation, intra-aortic balloon pump, or temporary ventricular assist device, there were no differences in survival between BTB and BTT at 1 and 5 years posttransplant, as well as 10 years posttransplant even after adjusting for baseline characteristics. The extracorporeal membrane oxygenation BTB group had greater rates of acute rejection (32.8% vs 13.6%; P = .002) and lower rates of dialysis (1.6% vs 21.4%; P < .001). For intra-aortic balloon pump and temporary ventricular assist device patients, there were no differences in posttransplant length of stay, acute rejection, airway compromise, stroke, dialysis, or pacemaker insertion between BTB and BTT recipients. Conclusions BTB patients have similar short- and midterm posttransplant survival as BTT patients. Future studies should continue to investigate the tradeoff between prolonged temporary mechanical circulatory support versus transitioning to durable mechanical circulatory support.
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Key Words
- BTB, bridge-to-bridge
- BTT, bridge-to-transplant
- CO, cardiac output
- ECMO, extracorporeal membrane oxygenation
- IABP, intra-aortic balloon pump
- LVAD, left ventricular assist device
- MCS, mechanical circulatory support
- OPTN, Organ Procurement and Transplantation Network
- PA, pulmonary artery
- PCWP, pulmonary capillary wedge pressure
- TAH, total artificial heart
- UNOS, United Network for Organ Sharing
- extracorporeal membrane oxygenation
- heart transplant
- intra-aortic balloon pump
- mPAP, mean pulmonary arterial pressure
- mechanical circulatory support
- tVAD, temporary ventricular assist device
- transplant outcomes
- ventricular assist devices
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Affiliation(s)
- Alice L. Zhou
- Johns Hopkins University School of Medicine, Baltimore, Md
| | - Eric W. Etchill
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | | | | | - Iulia Barbur
- Johns Hopkins University School of Medicine, Baltimore, Md
| | - Katherine A. Giuliano
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
- Address for reprints: Ahmet Kilic, MD, Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7107, 1800 Orleans St, Baltimore, MD 21287.
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