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  4. Impact of the Pre-Transplant Circulatory Supportive Strategy on Post-Transplant Outcome: Double Bridge May Work
 
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Impact of the Pre-Transplant Circulatory Supportive Strategy on Post-Transplant Outcome: Double Bridge May Work

Journal
Journal of clinical medicine
Journal Volume
10
Journal Issue
20
Date Issued
2021-10-13
Author(s)
NAI-KUAN CHOU  
HENG-WEN CHOU  
Tsao, Chuan-I
CHIH-HSIEN WANG  
Chen, Kevin Po-Hsun
NAI-HSIN CHI  
SHU-CHIEN HUANG  
HSI-YU YU  
YIH-SHARNG CHEN  
DOI
10.3390/jcm10204697
URI
https://scholars.lib.ntu.edu.tw/handle/123456789/589440
URL
https://api.elsevier.com/content/abstract/scopus_id/85117024788
Abstract
Background: The number of waitlisted patients requiring mechanical circulatory support (MCS) as a bridge to heart transplantation is increasing. The data concerning the results of the double-bridge strategy are limited. We sought to investigate the post-transplant outcomes across the different bridge strategies. Methods: We retrospectively reviewed a heart transplantation database from Jan 2009 to Jan 2019. Intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO), and ventricular assist devices (VAD) were the MCS that we investigated. The pre- and post-transplant characteristics and variables of patients bridged with the different types of MCS were collected. The post-transplant survival was compared using Kaplan-Meier survival analysis. Results: A total of 251 heart transplants were reviewed; 115 without MCS and 136 with MCS. The patients were divided to five groups: Group 1 (no MCS): n = 115; Group 2 (IABP): n = 15; Group 3 (ECMO): n = 33; Group 4 (ECMO-VAD): double-bridge (n = 59); Group 5 (VAD): n = 29. Survival analysis demonstrated that the 3-year post-transplant survival rates were significantly different among the groups (Log-rank p < 0.001). There was no difference in survival between group 4(ECMO-VAD) and group 1(no MCS)1 (p = 0.136), or between group 4(ECMO-VAD) and group 5(VAD) (p = 0.994). Group 3(ECMO) had significantly inferior 3-year survival than group 4(ECMO-VAD) and group 5(VAD). Conclusion: Double bridge may not lead to worse mid-term results in patients who could receive a transplantation. Initial stabilization with ECMO for critical patients before implantation of VAD might be considered as a strategy for obtaining an optimal post-transplant outcome.
Subjects
extracorporeal membrane oxygenation
heart transplantation
mechanical circulatory support
survival curve
timing
ventricular assist device
Publisher
MDPI
Type
journal article

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