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. 2021 Apr 5;54(2):99-105.
doi: 10.5090/jcs.20.115.

Impact of a Multidisciplinary Team Approach on Extracorporeal Circulatory Life Support-Bridged Heart Transplantation

Jae Jun Lee  1 , Young Su Kim  1 , Suryeun Chung  1 , Dong Seop Jeong  1 , Ji-Hyuk Yang  1 , Kiick Sung  1 , Wook Sung Kim  1 , Tae-Gook Jun  1 , Yang Hyun Cho  1
Affiliations

Impact of a Multidisciplinary Team Approach on Extracorporeal Circulatory Life Support-Bridged Heart Transplantation

Jae Jun Lee et al. J Chest Surg. .

Abstract

Background: The number of heart transplantations (HTx) is increasing annually. Due to advances in medical and surgical support, the outcomes of HTx are also improving. Extracorporeal circulatory life support (ECLS) provides patients with decompensated heart failure a chance to undergo HTx. A medical approach involving collaboration among experienced experts in different fields should improve the outcomes and prognosis of ECLSbridged HTx.

Methods: From December 2003 to December 2018, 1,465 patients received ECLS at Samsung Medical Center. We excluded patients who had not undergone HTx or underwent repeated transplantations. Patients younger than 18 years were excluded. We also excluded patients who received an implantable durable left ventricular assist device before HTx. In total, 91 patients were included in this study. A multidisciplinary team approach began in March 2013 at our hospital. We divided the patients into 2 groups depending on whether they were treated before or after implementation of the team approach.

Results: The 30-day mortality rate was significantly higher in the pre-ECLS team group than in the post-ECLS team group (n=5, 18.5% vs. n=2, 3.1%; p=0.023). The 1-year survival rate was better in the post-ECLS team group than in the pre-ECLS team group (n=57, 89.1% vs. n=19, 70.4%; p=0.023).

Conclusion: We found that implementing a multidisciplinary team approach improved the outcomes of ECLS-bridged HTx. Team-based care should be adapted at HTx centers that perform high-risk HTx.

Keywords: Extracorporeal circulation; Extracorporeal membrane oxygenation; Heart transplantation; Multidisciplinary team approach; Patient care team.

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Conflict of interest statement

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Flow chart of patient selection. ECLS, extracorporeal circulatory life support; HTx, heart transplantation; LVAD, left ventricular assist device.
Fig. 2
Fig. 2
Composition of the multidisciplinary ECLS team. ECLS, extracorporeal circulatory life support; ICU, intensive care unit.
Fig. 3
Fig. 3
Kaplan-Meier curve and log rank test of the pre- and post-ECLS team groups. One-year survival was better in the post-ECLS team group than in the pre-ECLS team group (n=57, 89.1% vs. n=19, 70.4%; p=0.023). ECLS, extracorporeal circulatory life support.
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