Impact of Left Ventricular Unloading on Outcome of Heart Transplant Bridging With Extracorporeal Membrane Oxygenation Support in New Allocation Policy.

التفاصيل البيبلوغرافية
العنوان:	Impact of Left Ventricular Unloading on Outcome of Heart Transplant Bridging With Extracorporeal Membrane Oxygenation Support in New Allocation Policy.
المؤلفون:	Gregory V; New York Medical College Valhalla NY USA., Okumura K; Division of Cardiothoracic Surgery, Department of Surgery Westchester Medical Center Valhalla NY USA., Isath A; Department of Cardiology Westchester Medical Center Valhalla NY USA., Levine A; New York Medical College Valhalla NY USA.; Department of Cardiology Westchester Medical Center Valhalla NY USA., De La Pena C; Division of Cardiothoracic Surgery, Department of Surgery Westchester Medical Center Valhalla NY USA., Shimamura J; New York Medical College Valhalla NY USA.; Division of Cardiothoracic Surgery, Department of Surgery Westchester Medical Center Valhalla NY USA., Spielvogel D; New York Medical College Valhalla NY USA.; Division of Cardiothoracic Surgery, Department of Surgery Westchester Medical Center Valhalla NY USA., Kai M; Division of Cardiac Surgery Beth Israel Deaconess Medical Center Boston MA USA., Ohira S; New York Medical College Valhalla NY USA.; Division of Cardiothoracic Surgery, Department of Surgery Westchester Medical Center Valhalla NY USA.
المصدر:	Journal of the American Heart Association [J Am Heart Assoc] 2024 May 21; Vol. 13 (10), pp. e033590. Date of Electronic Publication: 2024 May 14.
نوع المنشور:	Journal Article
اللغة:	English
بيانات الدورية:	Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE
أسماء مطبوعة:	Original Publication: Oxford : Wiley-Blackwell
مواضيع طبية MeSH:	Heart Transplantation* , Extracorporeal Membrane Oxygenation/methods , Heart-Assist Devices, Humans ; Male ; Female ; Middle Aged ; Adult ; Ventricular Function, Left ; Retrospective Studies ; Tissue and Organ Procurement/methods ; Treatment Outcome ; United States/epidemiology ; Heart Failure/physiopathology ; Heart Failure/mortality ; Heart Failure/therapy ; Heart Failure/surgery ; Time Factors ; Waiting Lists/mortality ; Intra-Aortic Balloon Pumping
مستخلص:	Background: The new heart allocation policy places veno-arterial extracorporeal membrane oxygenation (VA-ECMO)-supported heart transplant (HT) candidates at the highest priority status. Despite increasing evidence supporting left ventricular (LV) unloading during VA-ECMO, the effect of LV unloading on transplant outcomes following bridging to HT with VA-ECMO remains unknown. Methods and Results: From October 18, 2018 to March 21, 2023, 624 patients on VA-ECMO at the time of HT were identified in the United Network for Organ Sharing database and were divided into 2 groups: VA-ECMO alone (N=384) versus VA-ECMO with LV unloading (N=240). Subanalysis was performed in the LV unloading group: Impella (N=106) versus intra-aortic balloon pump (N=134). Recipient age was younger in the VA-ECMO alone group (48 versus 53 years, P =0.018), as was donor age (VA-ECMO alone, 29 years versus LV unloading, 32 years, P =0.041). One-year survival was comparable between groups (VA-ECMO alone, 88.0±1.8% versus LV unloading, 90.4±2.1%; P =0.92). Multivariable Cox hazard model showed LV unloading was not associated with posttransplant mortality after HT (hazard ratio, 0.92; P =0.70). Different LV unloading methods had similar 1-year survival (intra-aortic balloon pump, 89.2±3.0% versus Impella, 92.4±2.8%; P =0.65). Posttransplant survival was comparable between different Impella versions (Impella 2.5, versus Impella CP, versus Impella 5.0, versus Impella 5.5). Conclusions: Under the current allocation policy, LV unloading did not impact waitlist outcome and posttransplant survival in patients bridged to HT with VA-ECMO, nor did mode of LV unloading. This highlights the importance of a tailored approach in HT candidates on VA-ECMO, where routine LV unloading may not be universally necessary.
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فهرسة مساهمة:	Keywords: VA‐ECMO; heart failure; heart transplant; left ventricular unloading; mechanical circulatory support
تواريخ الأحداث:	Date Created: 20240514 Date Completed: 20240521 Latest Revision: 20240618
رمز التحديث:	20240618
مُعرف محوري في PubMed:	PMC11179799
DOI:	10.1161/JAHA.123.033590
PMID:	38742529
قاعدة البيانات:	MEDLINE

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تدمد:	2047-9980
DOI:	10.1161/JAHA.123.033590