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Finnan MJ, Bakir NH, Itoh A, Kotkar KD, Pasque MK, Damiano RJ, Moon MR, Ewald GA, Schilling JD, Masood MF. 30 Years of Heart Transplant: Outcomes after Mechanical Circulatory Support from a Single Center. Ann Thorac Surg 2021; 113:41-48. [PMID: 33675715 DOI: 10.1016/j.athoracsur.2021.01.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/31/2020] [Accepted: 01/19/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Survival after bridge to transplant with mechanical circulatory support (MCS) has yielded varying outcomes based on device type and baseline characteristics Continuous flow left ventricular assist devices (CF-LVADs) have significantly improved waitlist mortality, but recent changes to the transplant listing criteria have dramatically altered the use of MCS for bridge to transplant. METHODS Orthotopic heart transplants from 1988-2019 at our institution were retrospectively reviewed and stratified by pre-transplant MCS status into CF-LVAD (n=224), Pulsatile LVAD (n=49), temporary MCS (n=71), and primary transplant (n=463) groups. Patients transplanted after the approval of CF-LVAD for bridge to transplant and before the 2018 allocation policy changes underwent subgroup analysis to evaluate predictors of survival and complications in a contemporary cohort. RESULTS Rates of primary transplant declined from 88% to 14% over the course of the study. No significant difference in survival was detected in the cohort stratified by MCS status (P=0.18). In the modern era, survival for CF-LVAD and temporary MCS patients was non-inferior to primary transplant (P=0.22). Notable predictors of long-term mortality included lower body mass index, peripheral vascular disease, prior coronary artery bypass graft, ABO non-identical transplant, and increased donor age (all P<0.02). There were no differences in major postoperative complications. CONCLUSIONS CF-LVAD has grown to account for the majority of transplants at our center in the last decade with no adverse effect on survival or postoperative complications. Temporary MCS has increased following the 2018 listing criteria change with acceptable early outcomes.
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Affiliation(s)
- Michael J Finnan
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Nadia H Bakir
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Akinobu Itoh
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Kunal D Kotkar
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Michael K Pasque
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Ralph J Damiano
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Marc R Moon
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Gregory A Ewald
- Department of Medicine, Division of Cardiovascular Diseases, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Joel D Schilling
- Department of Medicine, Division of Cardiovascular Diseases, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri; Department of Pathology and Immunology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Muhammad F Masood
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
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Loyaga-Rendon RY, Fermin D, Jani M, Gonzalez M, Grayburn R, Lee S, Dickinson MG, Manandhar-Shrestha NK, Boeve T, Jovinge S, Leacche M. Changes in heart transplant waitlist and posttransplant outcomes in patients with restrictive and hypertrophic cardiomyopathy with the new heart transplant allocation system. Am J Transplant 2021; 21:1255-1262. [PMID: 32978873 DOI: 10.1111/ajt.16325] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/24/2020] [Accepted: 09/14/2020] [Indexed: 01/25/2023]
Abstract
Historically, patients with restrictive (RCM) and hypertrophic cardiomyopathy (HCM) experienced longer wait-times for heart transplant (HT) and increased waitlist mortality. Recently, a new HT allocation system was implemented in the United States. We sought to determine the impact of the new HT system on RCM/HCM patients. Adult patients with RCM/HCM listed for HT between November 2015 and September 2019 were identified from the UNOS database. Patients were stratified into two groups: old system and new system. We identified 872 patients who met inclusion criteria. Of these, 608 and 264 were classified in the old and new system groups, respectively. The time in the waitlist was shorter (25 vs. 54 days, P < .001), with an increased frequency of HT in the new system (74% vs. 68%, P = .024). Patients who were transplanted in the new system had a longer ischemic time, increased use of temporary mechanical circulatory support and mechanical ventilation. There was no difference in posttransplant survival at 9 months (91.1% vs. 88.9%) (p = .4). We conclude that patients with RCM/HCM have benefited from the new HT allocation system, with increased access to HT without affecting short-term posttransplant survival.
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Affiliation(s)
- Renzo Y Loyaga-Rendon
- Advanced Heart Failure Section, Spectrum Health, Michigan State University, Grand Rapids, Michigan
| | - David Fermin
- Advanced Heart Failure Section, Spectrum Health, Michigan State University, Grand Rapids, Michigan
| | - Milena Jani
- Advanced Heart Failure Section, Spectrum Health, Michigan State University, Grand Rapids, Michigan
| | - Matthew Gonzalez
- Advanced Heart Failure Section, Spectrum Health, Michigan State University, Grand Rapids, Michigan
| | - Ryan Grayburn
- Advanced Heart Failure Section, Spectrum Health, Michigan State University, Grand Rapids, Michigan
| | - Sangjin Lee
- Advanced Heart Failure Section, Spectrum Health, Michigan State University, Grand Rapids, Michigan
| | - Michael G Dickinson
- Advanced Heart Failure Section, Spectrum Health, Michigan State University, Grand Rapids, Michigan
| | | | - Theodore Boeve
- Division of Cardio Thoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - Stefan Jovinge
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan.,DeVos Cardiovascular Research Program, Van Andel Institute/Spectrum Health, Grand Rapids, Michigan.,Cardiovascular Institute, Stanford University, Palo Alto, California
| | - Marzia Leacche
- Division of Cardio Thoracic Surgery, Spectrum Health, Grand Rapids, Michigan
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Nordan T, Critsinelis AC, Chen FY, Kapur NK, Thayer KL, Couper GS, Kawabori M. One-Year Outcomes Following Heart Transplantation Under the New Donor Heart Allocation System in the United States. Circ Heart Fail 2021; 14:e007754. [PMID: 33504156 DOI: 10.1161/circheartfailure.120.007754] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Taylor Nordan
- Division of Cardiac Surgery (T.N., F.Y.C., G.S.C., M.K.), Tufts Medical Center, Boston, MA
| | | | - Frederick Y Chen
- Division of Cardiac Surgery (T.N., F.Y.C., G.S.C., M.K.), Tufts Medical Center, Boston, MA
| | - Navin K Kapur
- Division of Cardiology (N.K.K., K.L.T.), Tufts Medical Center, Boston, MA
| | - Katherine L Thayer
- Division of Cardiology (N.K.K., K.L.T.), Tufts Medical Center, Boston, MA
| | - Gregory S Couper
- Division of Cardiac Surgery (T.N., F.Y.C., G.S.C., M.K.), Tufts Medical Center, Boston, MA
| | - Masashi Kawabori
- Division of Cardiac Surgery (T.N., F.Y.C., G.S.C., M.K.), Tufts Medical Center, Boston, MA
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Sef D, Kabir T, Lees NJ, Stock U. Valvular complications following the Impella device implantation. J Card Surg 2021; 36:1062-1066. [PMID: 33410194 DOI: 10.1111/jocs.15303] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite clear clinical benefits, there is limited evidence regarding possible complications of the novel mechanical support device Impella. Aortic and mitral valve regurgitation or injury are rare but potential complications following implantation of the Impella device. METHODS To evaluate valvular complications after the Impella device implantation, we have performed a comprehensive search of literature on multiple sites on this topic. RESULTS AND CONCLUSION Ten case reports and one observational retrospective study were identified, with a total number of 19 patients identified. This article aims to draw attention to potential periprocedural complications relating to the Impella, in particular iatrogenic aortic and mitral valve injuries. Moreover, we have summarized our recommendations emphasizing the need for careful management and meticulous follow-up of these patients to avoid such potentially devastating complications.
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Affiliation(s)
- Davorin Sef
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Tito Kabir
- Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Nicholas James Lees
- Department of Anaesthesia and Critical Care, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Ulrich Stock
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
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Whitbread JJ, Giuliano KA, Etchill EW, Suarez-Pierre AI, Lawton JS, Hsu S, Sharma K, Choi CW, Higgins RSD, Kilic A. An Analysis of Waitlist Inactivity Among Patients With Ventricular Assist Devices. J Surg Res 2020; 260:383-390. [PMID: 33261857 DOI: 10.1016/j.jss.2020.11.010] [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: 07/08/2020] [Revised: 09/08/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Ventricular assist devices (VADs) are commonly used mechanical circulatory support for bridge to transplant therapy in end-stage heart failure; however, it is not understood how VADs influence incidence of waitlist inactive status. We sought to characterize and compare waitlist inactivity among patients with and without VADs. METHODS Using the Organ Procurement and Transplantation Network database, we investigated the VAD's impact on incidence and length of inactive periods for heart transplant candidates from 2005 through 2018. We compared median length of inactivity between patients with and without VADs and investigated inactivity risk with time-to-event regression models. RESULTS Among 46,441 heart transplant candidates, 32% (n = 14,636) had a VAD. Thirty-eight percent (n = 17,873) of all patients experienced inactivity, of which 42% (7538/17,873) had a VAD. Median inactivity length was 31 d for patients without VADs and 62 d for VAD patients (P < 0.0005). Multivariable analysis showed no significant difference in risk of inactivity for deteriorating conditions between patients with and without VADs after controlling for demographic and baseline clinical variables. A larger proportion of patients without VADs were inactive for deteriorating conditions than VAD patients (54%, n = 8242/15,221 versus 32%, n = 3583/11,086, P < 0.001). Ten percent (1155/11,086) of VAD patients' inactive periods were for VAD-related complications. CONCLUSIONS Although VAD patients were inactive longer and had an overall increased risk of any-cause inactivity, their risk of inactivity for deteriorating condition was not significantly different from patients without VADs. Furthermore, VAD patients had a smaller proportion of inactivity periods due to deteriorating conditions. Thus, VADs are protective from morbidity for waitlist patients.
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Affiliation(s)
| | - Katherine A Giuliano
- Division of Cardiac Surgery, Johns Hopkins Hospital, Cardiac Surgery, Baltimore, Maryland
| | - Eric W Etchill
- Division of Cardiac Surgery, Johns Hopkins Hospital, Cardiac Surgery, Baltimore, Maryland
| | | | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins Hospital, Cardiac Surgery, Baltimore, Maryland
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kavita Sharma
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Chun W Choi
- Division of Cardiac Surgery, Johns Hopkins Hospital, Cardiac Surgery, Baltimore, Maryland
| | - Robert S D Higgins
- Division of Cardiac Surgery, Johns Hopkins Hospital, Cardiac Surgery, Baltimore, Maryland
| | - Ahmet Kilic
- Division of Cardiac Surgery, Johns Hopkins Hospital, Cardiac Surgery, Baltimore, Maryland.
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Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review. J Clin Med 2020; 9:jcm9123905. [PMID: 33271929 PMCID: PMC7761005 DOI: 10.3390/jcm9123905] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/02/2023] Open
Abstract
Treatment of giant cell myocarditis (GCM) can require bridging to orthotopic heart transplantation (OHT) or recovery with mechanical circulatory support (MCS). Since the roles of MCS and immunotherapy are not well-defined in GCM, we sought to analyze outcomes of patients with GCM who required MCS. A systematic search was performed in June 2019 to identify all studies of biopsy-proven GCM requiring MCS after 2009. We identified 27 studies with 43 patients. Patient-level data were extracted for analysis. Median patient age was 45 (interquartile range (IQR): 32-57) years. 42.1% (16/38) were female. 34.9% (15/43) presented in acute heart failure. 20.9% (9/43) presented in cardiogenic shock. Biventricular (BiVAD) MCS was required in 76.7% (33/43) of cases. Of the 62.8% (27/43) of patients who received immunotherapy, 81.5% (22/27) used steroids combined with at least one other immunosuppressant. Cyclosporine was the most common non-steroidal agent, used in 40.7% (11/27) of regimens. Immunosuppression was initiated before MCS in 59.3% (16/27) of cases, after MCS in 29.6% (8/27), and not specified in 11.1% (3/27). Immunosuppression started prior to MCS was associated with significantly better survival than MCS alone (p = 0.006); 60.5% (26/43) of patients received bridge-to-transplant MCS; 39.5% (17/43) received bridge-to-recovery MCS; 58.5% (24/41) underwent OHT a median of 104 (58-255) days from diagnosis. GCM recurrence after OHT was reported in 8.3% (2/24) of transplanted cases. BiVAD predominates in mechanically supported patients with GCM. Survival and bridge to recovery appear better in patients on immunosuppression, especially if initiated before MCS.
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Improved survival after heart transplantation in patients bridged with extracorporeal membrane oxygenation in the new allocation system. J Heart Lung Transplant 2020; 40:149-157. [PMID: 33277169 DOI: 10.1016/j.healun.2020.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Historically, patients bridged on extracorporeal membrane oxygenation (ECMO) to heart transplantation (HT) have very high post-transplant mortality. In the new heart transplant allocation system, ECMO-supported patients have the highest priority for HT. However, data are lacking on the outcomes of these critically ill patients. We compared the waitlist and post-transplant outcomes of ECMO-supported patients in the new and old allocation systems. METHODS Adult patients supported by ECMO at the time of listing or transplantation who were registered in the United Network for Organ Sharing database between November 1, 2015 and September 30, 2019 were included. Clinical characteristics, outcomes in the waitlist, and post-transplant survival were compared between the old and new systems. Cox Proportional and subdistribution hazard regression models were used to evaluate the variables contributing to the post-transplant and waitlist outcomes RESULTS: A total of 296 ECMO-supported patients were listed for HT. Of these, 191 were distributed to the old system, and 105 were distributed to the new system. Patients listed in the new system had a higher cumulative incidence of HT (p < 0.001) and lower incidence of death or removal (p = 0.001) from the transplant list than patients listed in the old system. The 6-month survival after transplantation was 74.6% and 90.6% for the old- and new-era patients, respectively (p = 0.002). Among ECMO-supported patients, being listed or transplanted on the new system was independently associated with improved outcomes in the waitlist and after transplantation. CONCLUSIONS With the implementation of the new heart transplant allocation system, ECMO-supported patients have a shorter waitlist time, improved frequency of HT, and improved short-term post-transplant survival.
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Monteagudo-Vela M, Panoulas V, García-Saez D, de Robertis F, Stock U, Simon AR. Outcomes of heart transplantation in patients bridged with Impella 5.0: Comparison with native chest transplanted patients without preoperative mechanical circulatory support. Artif Organs 2020; 45:254-262. [PMID: 32936936 DOI: 10.1111/aor.13816] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/19/2022]
Abstract
The Impella (Abiomed, Danvers, MA, USA) has become an important adjunct treatment modality in bridging patients with end-stage heart failure to recovery or orthotopic heart transplantation (HTx). We compared the outcome of patients directly bridged to HTx with the Impella 5.0 versus patients without mechanical circulatory support (MCS). Patients with no previous sternotomy or MCS, who were transplanted between September 2014 and March 2019 were included in this retrospective analysis. Impella 5.0 was implanted using surgical access and transesophageal echocardiography guidance. Forty-two out of 155 transplanted patients fulfilled the insertion criteria. Eight (19%) were bridged with Impella 5.0 to HTx. Recipient and donor baseline characteristics were comparable in both groups. There were no significant differences in survival between the groups at 30-day (94% no MCS vs. 87.5% Impella group, P = .47) or 6 months (94% vs. 87.5%, P = .51). Patients on Impella 5.0 showed a significant recovery of hemodynamic parameters and end-organ function. Average duration of support to HTx was 16 ± 17 days. Impella 5.0, when used in suitable patients in a timely fashion can be a good strategy for bridging patients to HTx. The axillary approach allows for early extubation and mobilization. Outcomes of patients bridged to HTx with Impella 5.0 in acute cardiogenic shock are comparable to those of patients with no MCS.
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Affiliation(s)
- María Monteagudo-Vela
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Diana García-Saez
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Fabio de Robertis
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ulrich Stock
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Andre Rudiger Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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The introduction of a super-urgent heart allocation scheme in the UK: A 2-year review. J Heart Lung Transplant 2020; 39:1109-1117. [DOI: 10.1016/j.healun.2020.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 11/21/2022] Open
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Alam A, Meyer DM, Hall SA. Commentary: History is prologue: If we fail to learn from our past, we are doomed to repeat it. J Thorac Cardiovasc Surg 2020; 161:1847-1848. [PMID: 32981710 DOI: 10.1016/j.jtcvs.2020.08.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Amit Alam
- Center for Advanced Heart and Lung Disease, Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Tex; Division of Cardiology, Department of Advanced Heart Failure, Mechanical Support, and Transplant, Baylor Heart and Vascular Hospital, Dallas, Tex; Texas A&M University College of Medicine, Bryan, Tex
| | - Dan M Meyer
- Center for Advanced Heart and Lung Disease, Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Tex; Texas A&M University College of Medicine, Bryan, Tex; Center for Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Tex
| | - Shelley A Hall
- Center for Advanced Heart and Lung Disease, Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Tex; Division of Cardiology, Department of Advanced Heart Failure, Mechanical Support, and Transplant, Baylor Heart and Vascular Hospital, Dallas, Tex; Texas A&M University College of Medicine, Bryan, Tex.
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Estep JD, Soltesz E, Cogswell R. The new heart transplant allocation system: Early observations and mechanical circulatory support considerations. J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)32638-6. [PMID: 34756380 DOI: 10.1016/j.jtcvs.2020.08.113] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/30/2020] [Accepted: 08/08/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Jerry D Estep
- Department of Cardiovascular Medicine, Cleveland Clinic Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute, Cleveland, Ohio; Kaufman Center for Heart Failure and Recovery, Cleveland Clinic, Cleveland, Ohio.
| | - Edward Soltesz
- Kaufman Center for Heart Failure and Recovery, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute, Cleveland, Ohio
| | - Rebecca Cogswell
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, Minn
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"Unintended" Consequences of Changes in Heart Transplant Allocation Policy: Impact on Practice Patterns. ASAIO J 2020; 66:125-127. [PMID: 31977354 DOI: 10.1097/mat.0000000000001128] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Nordan T, Hironaka CE, Kawabori M. Temporary Mechanical Circulatory Support as a Bridge to Transplant: Return of the Intra-Aortic Balloon Pump. JACC-HEART FAILURE 2020; 8:785-786. [PMID: 32883445 DOI: 10.1016/j.jchf.2020.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022]
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Kawabori M, Nordan T, Chen FY, Couper GS. Post-CABG sternum sparing biventricular assist device implantation technique using the right pulmonary artery for right ventricular assist device outflow cannulation. J Artif Organs 2020; 24:301-304. [PMID: 32676808 DOI: 10.1007/s10047-020-01193-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Masashi Kawabori
- Department of Cardiac Surgery, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA.
| | - Taylor Nordan
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA.
| | - Frederick Y Chen
- Department of Cardiac Surgery, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA
| | - Gregory S Couper
- Department of Cardiac Surgery, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA
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Bartfay SE, Dellgren G, Hallhagen S, Wåhlander H, Dahlberg P, Redfors B, Ekelund J, Karason K. Durable circulatory support with a paracorporeal device as an option for pediatric and adult heart failure patients. J Thorac Cardiovasc Surg 2020; 161:1453-1464.e4. [PMID: 32653285 DOI: 10.1016/j.jtcvs.2020.04.163] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Not all patients in need of durable mechanical circulatory support are suitable for a continuous-flow left ventricular assist device. We describe patient populations who were treated with the paracorporeal EXCOR, including children with small body sizes, adolescents with complex congenital heart diseases, and adults with biventricular failure. METHODS Information on clinical data, echocardiography, invasive hemodynamic measurements, and surgical procedures were collected retrospectively. Differences between various groups were compared. RESULTS Between 2008 and 2018, a total of 50 patients (21 children and 29 adults) received an EXCOR as bridge to heart transplantation or myocardial recovery. The majority of patients had heart failure compatible with Interagency Registry for Mechanically Assisted Circulatory Support profile 1. At year 5, the overall survival probability for children was 90%, and for adults 75% (P = .3). After we pooled data from children and adults, the survival probability between patients supported by a biventricular assist device was similar to those treated with a left ventricular assist device/ right ventricular assist device (94% vs 75%, respectively, P = .2). Patients with dilated cardiomyopathy had a trend toward better survival than those with other heart failure etiologies (92% vs 70%, P = .05) and a greater survival free from stroke (92% vs 64%, P = .01). Pump house exchange was performed in nine patients due to chamber thrombosis (n = 7) and partial membrane rupture (n = 2). There were 14 cases of stroke in eleven patients. CONCLUSIONS Despite severe illness, patient survival on EXCOR was high, and the long-term overall survival probability following heart transplantation and recovery was advantageous. Treatment safety was satisfactory, although still hampered by thromboembolism, mechanical problems, and infections.
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Affiliation(s)
- Sven-Erik Bartfay
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Göran Dellgren
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Hallhagen
- Department of Pediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Håkan Wåhlander
- Department of Pediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pia Dahlberg
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Redfors
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Ekelund
- Centre of Registers Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristjan Karason
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
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66
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Reich H, Ramzy D, Moriguchi J, Dimbil S, Levine R, Passano E, Kittleson M, Cole R, Czer L, Chang D, Geft D, Trento A, Chikwe J, Kobashigawa J, Esmailian F. Acceptable Post-Heart Transplant Outcomes Support Temporary MCS Prioritization in the New OPTN|UNOS Heart Allocation Policy. Transplant Proc 2020; 53:353-357. [PMID: 32650992 DOI: 10.1016/j.transproceed.2020.04.1819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/16/2020] [Accepted: 04/25/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Temporary mechanical circulatory support (MCS) devices are generally used short term to maintain adequate organ perfusion in patients with advanced heart failure and cardiogenic shock. Unacceptably high waitlist mortality in this cohort motivated changes to heart allocation policy, which recognized the severity of illness by prioritization for temporary MCS and broader sharing in the new U.S. donor heart allocation policy. We evaluated the post-heart transplant outcomes for patients bridged with temporary MCS, a control population not bridged with MCS, and a cohort bridged with durable MCS. METHODS The heart transplant research database was queried to identify patients bridged with temporary MCS and bridged with durable MCS who went directly to heart transplant in our center. Temporary MCS included Impella, intra-aortic balloon pump, and extracorporeal membrane oxygenation. Post-transplant endpoints were assessed at 30 days, 6 months, and 1 year. RESULTS From 2010 to 2017, a total of 23 patients were bridged to heart transplant with temporary MCS and 548 were transplanted without MCS bridge. Patients bridged with temporary MCS had younger age, lower body mass index, and higher frequencies of prior blood transfusion and Status 1 (1A/1B) listing at transplant compared to patients not bridged with MCS (all P < .001). Despite the severity of illness in patients bridged with temporary MCS, post-transplant outcomes were indistinguishable from those in patients transplanted without MCS bridge, with no difference in 30-day, 6-month, or 1-year survival or 1-year freedom from cardiac allograft vasculopathy, nonfatal major adverse cardiac events, any-treated rejection, acute cellular rejection, or antibody-mediated rejection (P = .23-.97). Similarly, compared to 157 patients bridged with durable MCS, no differences in post-transplant outcomes were identified for the temporary MCS cohort (P = .15-.94). CONCLUSION Temporary MCS as a bridge to transplant achieves similar post-transplant outcomes at 1 year compared to no MCS and durable MCS. These encouraging findings support recent changes in the Organ Procurement and Transplantation Network | United Network Organ Sharing (OPTN|UNOS) adult heart allocation policy.
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Affiliation(s)
- Heidi Reich
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Danny Ramzy
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Jaime Moriguchi
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Sadia Dimbil
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Ryan Levine
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Elizabeth Passano
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Michelle Kittleson
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Robert Cole
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Lawrence Czer
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - David Chang
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Dael Geft
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Alfredo Trento
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Joanna Chikwe
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Jon Kobashigawa
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Fardad Esmailian
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States.
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67
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Preoperative Extracorporeal Membrane Oxygenation Implantation in Heart Transplantation. A Cautious Interpretation. Crit Care Med 2020; 48:e630-e631. [PMID: 32568914 DOI: 10.1097/ccm.0000000000004336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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68
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Giordanino EF, Absi DO, Favaloro LE, Renedo MF, Ratto RD, Rubira DM, Ameri A, Giunta G, Favaloro RR, Bertolotti AM. Short-term mechanical circulatory support devices as bridge to heart transplantation: A prospective single-center experience in Argentina. Clin Transplant 2020; 34:e13888. [PMID: 32358983 DOI: 10.1111/ctr.13888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with cardiogenic shock may require hemodynamic stabilization with short-term mechanical circulatory support devices (ST-MCS) such as extracorporeal membrane oxygenation (ECMO) and centrifugal pump (CP) as bridge to transplantion (BTT). This study aimed to describe ECMO and CP during BTT and after heart transplant. METHODS A cohort of patients on ECMO or CP as BTT between April 2006 and April 2018 in a single hospital. RESULTS Thirty-seven consecutive patients with ECMO (n = 14) or CP (n = 23) were included. Acute kidney injury was more prevalent during CP (28.6% vs 69.6%, P = .02). There were no differences in stroke, thrombosis, sepsis, or vasoplegia. Bleeding (0% vs 56.5%, P = .0003) and reoperation (0% vs 47.8%, P = .002) were more frequent in CP group as well as mortality (0 vs 7 [30.4%], P = .03). The remaining 30 patients (81.1%) underwent heart transplantation, without differences in primary graft dysfunction, vasoplegia, reoperation for bleeding, or hospital stay. Mortality was 23.3% at 30 days, similar in both groups, with no further deaths at median follow-up of 44.2 months. CONCLUSIONS In patients with cardiogenic shock, ST-MCS with ECMO or CP as BTT are a lifesaving approach allowing successful transplantation in the majority of cases, with good short- and long-term survival.
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Affiliation(s)
- Elian F Giordanino
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Daniel O Absi
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Liliana E Favaloro
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Maria F Renedo
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Roxana D Ratto
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Daniela M Rubira
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Aldana Ameri
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Gustavo Giunta
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Roberto R Favaloro
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Alejandro M Bertolotti
- Department of Heart Failure and Heart Transplant, Favaloro Foundation University Hospital, Buenos Aires, Argentina
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69
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Short-term mechanical circulatory support: Transitioning the patient to the next stage. JTCVS OPEN 2020; 2:29-34. [PMID: 36003683 PMCID: PMC9390519 DOI: 10.1016/j.xjon.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/20/2020] [Accepted: 04/02/2020] [Indexed: 12/02/2022]
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70
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Reassessing Recipient Mortality Under the New Heart Allocation System: An Updated UNOS Registry Analysis. JACC-HEART FAILURE 2020; 8:548-556. [PMID: 32417413 DOI: 10.1016/j.jchf.2020.03.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/18/2020] [Accepted: 03/06/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND An early report of recipient heart transplantation outcomes under the new U.S. heart allocation system introduced in late 2018 found a lower post-transplant survival rate compared with that of the prior system. OBJECTIVES The aim of this study was to examine recipient survival under the new system by using an updated dataset. METHODS The 2015 to 2019 United Network for Organ Sharing registry was queried for adult heart transplant recipients, stratified according to whether the subjects were listed and underwent transplant before or after October 18, 2018, when the new allocation system was implemented. The association between allocation system and recipient mortality was analyzed by using the Kaplan-Meier method and multivariable Cox proportional hazards regression. RESULTS A total of 7,119 recipients met inclusion criteria: 6,004 (84%) and 1,115 (16%) listed and undergoing transplant in the old and new allocation systems, respectively. This registry update included 576 new-system recipients, more than double the amount previously analyzed. Recipients from the new system were more likely to be bridged to transplant with temporary mechanical circulatory support devices instead of durable left ventricular assist devices and had longer graft ischemic times. After adjustment, the new system was not associated with poorer survival on Kaplan-Meier survival analysis (log-rank test; p = 0.075) or multivariable Cox proportional hazards modeling (adjusted hazard ratio: 1.18; 95% confidence interval: 0.90 to 1.55). CONCLUSIONS The short-term survival of recipients listed and receiving a transplant under the old and new allocation systems seems to be comparable. The modification to the allocation system has resulted in several changes to the clinical profiles of patients undergoing transplants that must be closely monitored in the coming years.
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71
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Taylor LJ, Fiedler AG. Balancing supply and demand: Review of the 2018 donor heart allocation policy. J Card Surg 2020; 35:1583-1588. [DOI: 10.1111/jocs.14609] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Lauren J. Taylor
- Division of Cardiothoracic Surgery, Department of Surgery University of Wisconsin Madison Wisconsin
| | - Amy G. Fiedler
- Division of Cardiothoracic Surgery, Department of Surgery University of Wisconsin Madison Wisconsin
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72
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Seese L, Hickey G, Keebler ME, Mathier MA, Sultan I, Gleason TG, Toma C, Kilic A. Direct bridging to cardiac transplantation with the surgically implanted Impella 5.0 device. Clin Transplant 2020; 34:e13818. [DOI: 10.1111/ctr.13818] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/04/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Laura Seese
- Division of Cardiac Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Gavin Hickey
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
- Division of Cardiology University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Mary E. Keebler
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
- Division of Cardiology University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Michael A. Mathier
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
- Division of Cardiology University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Thomas G. Gleason
- Division of Cardiac Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Catalin Toma
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
- Division of Cardiology University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania
- Heart and Vascular Institute University of Pittsburgh Medical Center Pittsburgh Pennsylvania
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73
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Seese L, Hickey G, Keebler ME, Mathier MA, Sultan I, Gleason TG, Wang Y, Kilic A. Temporary left ventricular assist devices as a bridge to heart transplantation. J Card Surg 2020; 35:810-817. [PMID: 32092194 DOI: 10.1111/jocs.14466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND To create equitable access to donor organs for the highest mortality patients, the cardiac transplant allocation system now prioritizes patients with surgically implanted temporary left ventricular assist devices (T-LVADs). The outcomes following a direct bridge from a T-LVAD to orthotopic heart transplant (OHT) are not well delineated. AIM This study investigates the T-LVAD waitlist outcomes and compares the posttransplant outcomes in patients bridged to OHT with surgically implanted T-LVADs to patients bridged with durable continuous-flow left ventricular assist devices (CF-LVADs). METHODS Adults recorded in the United Network for Organ Sharing registry bridged to OHT with a durable CF-LVAD and T-LVADs, with or without temporary right ventricular assist devices (T-RVADs), between 2010 and 2018 were included. Propensity matching and multivariable Cox regression were utilized to compare outcomes. RESULTS Of 504 patients waitlisted with T-LVADs, the majority were transplanted (50%), bridged to CF-LVAD (17%), or recovered (9%). A total of 9047 recipients were bridged to OHT during the study period with 8875 CF-LVADs and 172 T-LVADs. Early survival in propensity-matched T-LVAD ± T-RVAD patients was similar to CF-LVAD ± T-RVAD patients but reduced at a 1-year follow-up. This difference in survival at 1-year follow-up was attributable to significantly reduced survival in patients with combined T-LVAD + T-RVAD support when compared with CF-LVAD, isolated T-LVAD and combined CF-LVAD + T-RVAD support (80% vs 90% vs 90% vs 91%; P = .005). CONCLUSIONS This study demonstrates that most patients waitlisted with a T-LVAD are successfully bridged to durable therapy or recover, and those bridged to OHT have acceptable posttransplant outcomes, particularly when T-RVADs are not required.
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Affiliation(s)
- Laura Seese
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gavin Hickey
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary E Keebler
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael A Mathier
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yisi Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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74
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Pal N, Stansfield J, Mukhopadhyay N, Nelson M. Marginal Improvement in Survival Post-Heart Transplantation in Patients With Prior Left Ventricular Assist Device: A Temporal Analysis of United Network of Organ Sharing Registry. J Cardiothorac Vasc Anesth 2020; 34:392-400. [DOI: 10.1053/j.jvca.2019.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 11/11/2022]
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75
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Pal N, Gay SH, Boland CG, Lim AC. Heart Transplantation After Ventricular Assist Device Therapy: Benefits, Risks, and Outcomes. Semin Cardiothorac Vasc Anesth 2020; 24:9-23. [DOI: 10.1177/1089253219898985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Heart transplantation is an established treatment for end-stage heart failure. Due to the increase in demand and persistent scarcity of organ, mechanical circulatory devices have played a major role in therapy for advanced heart failure. Usage of left ventricular assist device (LVAD) has gone up from 6% in 2006 to 43% in 2013 as per the United Network of Organ Sharing database. Majority of patients presenting for a heart transplantation are often bridged with an assist device prior for management of heart failure while on wait-list. On one hand, it is well established that LVADs improve survival on wait-list; on the other hand, the effect of LVAD on morbidity and survival after a heart transplantation is still unclear. In this article, we review the available literature and attempt to infer the outcomes given the risks and benefits of heart transplantation with prior LVAD patients.
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Affiliation(s)
- Nirvik Pal
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Aaron C. Lim
- Virginia Commonwealth University, Richmond, VA, USA
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76
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Cogswell R, John R, Estep JD, Duval S, Tedford RJ, Pagani FD, Martin CM, Mehra MR. An early investigation of outcomes with the new 2018 donor heart allocation system in the United States. J Heart Lung Transplant 2020; 39:1-4. [DOI: 10.1016/j.healun.2019.11.002] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022] Open
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77
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Araj FG. Temporary mechanical circulatory support devices and post-transplant outcome: Not all devices are created equal. J Heart Lung Transplant 2019; 38:1323. [PMID: 31630944 DOI: 10.1016/j.healun.2019.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Faris G Araj
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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78
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Bernhardt AM. The new tiered allocation system for heart transplantation in the United States—a Faustian bargain. J Heart Lung Transplant 2019; 38:870-871. [DOI: 10.1016/j.healun.2019.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/18/2019] [Accepted: 05/18/2019] [Indexed: 10/26/2022] Open
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79
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Farrero M, Flores‐Umanzor EJ, Pomar JL, Sagarra J, Santiago E, Perez‐Villa F. Elective or emergency heart transplantation: Cost comparison in a single center. Clin Transplant 2019; 33:e13596. [DOI: 10.1111/ctr.13596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/24/2019] [Accepted: 05/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Marta Farrero
- Cardiology Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Eduardo J. Flores‐Umanzor
- Cardiology Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Jose Luis Pomar
- Cardiovascular Surgery Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Joan Sagarra
- Department of Economics, Respiratory Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Evelyn Santiago
- Cardiology Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
| | - Felix Perez‐Villa
- Cardiology Department, Cardiovascular Institute, Hospital Clínic University of Barcelona Barcelona Spain
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