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. 2020 Aug;13(8):e006971.
doi: 10.1161/CIRCHEARTFAILURE.120.006971. Epub 2020 Aug 6.

Intra-Aortic Balloon Pump Bridging to Heart Transplantation: Impact of the 2018 Allocation Change

Lauren V Huckaby  1 , Laura M Seese  1 , Michael A Mathier  2 , Gavin W Hickey  2 , Arman Kilic  1
Affiliations

Intra-Aortic Balloon Pump Bridging to Heart Transplantation: Impact of the 2018 Allocation Change

Lauren V Huckaby et al. Circ Heart Fail. 2020 Aug.

Abstract

Background: This study evaluates the impact of the 2018 allocation policy change on outcomes of orthotopic heart transplantation (OHT) in patients bridged with intra-aortic balloon pumps (IABPs).

Methods: Adult (≥18 years) patients undergoing OHT between 2013 and 2019 who were bridged with an IABP were stratified based on temporal relation to the policy change. Univariate analysis was used to compare baseline characteristics and postoperative outcomes. Multivariate Cox regression analysis was used to estimate risk-adjusted predictors of post-transplant mortality.

Results: A total of 1342 (8.6%) OHT patients were bridged with an IABP during the study period. Rates of bridging with IABP to OHT increased significantly after the policy change (7.0% versus 24.9%, P<0.001). The mean recipient age was 54.1±12.1 years with 981 (73.1%) patients being male. Baseline characteristics were similar between the 2 groups whereas post-policy change patients spent fewer days on the waitlist (15 versus 35 days, P<0.001), had longer ischemic times (3.5 versus 3.0 hours, P<0.001), and received organs from a greater distance (301 versus 105 miles, P<0.001). By multivariable analysis, days on the waitlist (for every 30 days; odds ratio, 1.01 [95% CI, 1.00-1.02], P=0.031) and diabetes mellitus (odds ratio, 1.87 [95% CI, 1.16-3.02], P=0.011) emerged as significant predictors of post-transplant mortality. After the policy change, waitlisted patients requiring IABP support were more likely to survive to transplant (76.4 versus 89.8%, P<0.001).

Conclusions: IABP utilization has increased over 3-fold since the 2018 policy change with improved waitlist outcomes and comparable post-OHT survival. Thus, bridging patients to OHT with IABPs appears to be an effective strategy in the current era.

Keywords: heart failure; heart transplantation; retrospective studies.

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Conflict of interest statement

Disclosures

Dr Kilic serves on a Medical Advisory Board for Medtronic, Inc. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
Heart transplantations in the United States each year since 2013, stratified by the use of an intra-aortic balloon pump (IABP; shown in red).
Figure 2.
Figure 2.
Kaplan-Meier survival analysis of outcomes following orthotopic heart transplantation in patients bridged with an intra-aortic balloon pump undergoing surgery before or after the policy change.
See this image and copyright information in PMC

Comment in

  • Will Status 2 Become the New 1A?
    Cogswell R. Cogswell R. Circ Heart Fail. 2020 Aug;13(8):e007292. doi: 10.1161/CIRCHEARTFAILURE.120.007292. Epub 2020 Aug 6. Circ Heart Fail. 2020. PMID: 32757646 No abstract available.

References

    1. OPTN/UNOS Policy Notice Proposal to Modify the Adult Heart Allocation System. 2018. 1–38. Available at: https://optn.transplant.hrsa.gov/media/2028/thoracic_policynotice_201612.... Accessed January 12, 2020.
    1. Gjesdal O, Gude E, Arora S, Leivestad T, Andreassen AK, Gullestad L, Aaberge L, Brunvand H, Edvardsen T, Geiran OR, et al. Intra-aortic balloon counterpulsation as a bridge to heart transplantation does not impair long-term survival. Eur J Heart Fail. 2009;11:709–714. doi: 10.1093/eurjhf/hfp078 - DOI - PubMed
    1. Albert CL, Hsich E, Unai S, Tong M, Soltesz E, Estep JD. The safety and efficacy intra-aortic balloon pump as a bridge to transplant strategy under the new UNOS allocation. J Card Fail. 2019;25:S161. Abstract.
    1. Estep JD, Cordero-Reyes AM, Bhimaraj A, Trachtenberg B, Khalil N, Loebe M, Bruckner B, Orrego CM, Bismuth J, Kleiman NS, et al. Percutaneous placement of an intra-aortic balloon pump in the left axillary/subclavian position provides safe, ambulatory long-term support as bridge to heart transplantation. JACC Heart Fail. 2013;1:382–388. doi: 10.1016/j.jchf.2013.06.002 - DOI - PubMed
    1. Vucicevic D, Honoris L, Chang A, Moreno E, Salimbangon A, Moore M, Sweet L, Shah S, Iyengar A, Pandya K, et al. The use of intra-aortic balloon pump pre-transplant is associated with worse outcomes in heart transplant recipients. J Heart Lung Transplant. 2017;36:S304. Abstract.

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