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. 2019 Jul;158(1):171-181.e1.
doi: 10.1016/j.jtcvs.2019.01.135. Epub 2019 Feb 28.

Outcomes of bridge to cardiac retransplantation in the contemporary mechanical circulatory support era

Joseph E Sanchez  1 , Hiroo Takayama  1 , Masahiko Ando  1 , Jiho Han  2 , Paul Kurlansky  1 , Arthur R Garan  3 , Veli K Topkara  3 , Maryjane Farr  3 , Paolo C Colombo  3 , Yoshifumi Naka  1 , Koji Takeda  4
Affiliations
Free article

Outcomes of bridge to cardiac retransplantation in the contemporary mechanical circulatory support era

Joseph E Sanchez et al. J Thorac Cardiovasc Surg. 2019 Jul.
Free article

Abstract

Background: Outcomes have improved in patients bridged to heart transplant on contemporary continuous-flow ventricular assist devices over the past decade. We evaluated mechanical circulatory support as a means to bridge patients to cardiac retransplantation.

Methods: We retrospectively reviewed 464 patients who underwent cardiac retransplant from the United Network for Organ Sharing database between January 2006 and November 2016. Pre- and post-transplant data were compared between patients bridged to retransplant with mechanical circulatory support (n = 81) and those without mechanical circulatory support (n = 383).

Results: The mean ages for the patients in the mechanical circulatory support and nonmechanical circulatory support cohorts were 41.2 ± 16 years and 42.1 ± 15.7 years, respectively (P = .64). Patients bridged with mechanical circulatory support were placed on extracorporeal membrane oxygenation (n = 29, 35.8%), a total artificial heart (n = 13, 16.0%), or a temporary or durable ventricular assist device (n = 39, 48.1%). Twelve patients (14.8%) were placed on a second device before retransplant. Thirty-nine percent of the mechanical circulatory support group were indicated for listing because of primary graft dysfunction or acute rejection versus 6% of the nonmechanical circulatory support group (P < .01). Likewise, 30% of patients in the mechanical circulatory support group were listed for cardiac allograft vasculopathy compared with 59% of the nonmechanical circulatory support group (P < .01). Thirty-day mortality was significantly higher in the mechanical circulatory support group (17.8% vs 4.8%, P < .01). However, patients who were bridged with a ventricular assist device or total artificial heart had comparable midterm outcomes to the nonmechanical circulatory support group.

Conclusions: Patients who require mechanical circulatory support bridge to retransplantation belong to a high-risk cohort. Comparable midterm outcomes to the nonmechanical circulatory support cohort were demonstrated when patients' conditions allow for bridge with a ventricular assist device or total artificial heart. Bridging to retransplantation with extracorporeal membrane oxygenation remains a relative contraindication.

Keywords: bridge to transplant; mechanical circulatory support; retransplant.

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