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. 2020 Jul;34(7):e13888.
doi: 10.1111/ctr.13888. Epub 2020 Jun 2.

Short-term mechanical circulatory support devices as bridge to heart transplantation: A prospective single-center experience in Argentina

Elian F Giordanino  1 , Daniel O Absi  1 , Liliana E Favaloro  1 , Maria F Renedo  1 , Roxana D Ratto  1 , Daniela M Rubira  1 , Aldana Ameri  1 , Gustavo Giunta  1 , Roberto R Favaloro  1 , Alejandro M Bertolotti  1
Affiliations

Short-term mechanical circulatory support devices as bridge to heart transplantation: A prospective single-center experience in Argentina

Elian F Giordanino et al. Clin Transplant. 2020 Jul.

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.

Keywords: extracorporeal membrane oxygenation; heart transplantation; heart-assist devices.

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References

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