Impact of left ventricular unloading on postheart transplantation outcomes in patients bridged with VA-ECMO.

IF 7.2 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Revista española de cardiología (English ed.) Pub Date : 2024-10-09 DOI:10.1016/j.rec.2024.09.005

Daniel Enríquez-Vázquez, Eduardo Barge-Caballero, Francisco González-Vílchez, Luis Almenar-Bonet, María Dolores García-Cosío Carmena, José González-Costello, Manuel Gómez-Bueno, María Ángeles Castel-Lavilla, Beatriz Díaz-Molina, Manuel Martínez-Sellés, Sonia Mirabet-Pérez, Luis De La Fuente-Galán, Daniela Hervás-Sotomayor, Diego Rangel-Sousa, Iris P Garrido-Bravo, Teresa Blasco-Peiró, Gregorio Rábago Juan-Aracil, Javier Muñiz, María G Crespo-Leiro

{"title":"Impact of left ventricular unloading on postheart transplantation outcomes in patients bridged with VA-ECMO.","authors":"Daniel Enríquez-Vázquez, Eduardo Barge-Caballero, Francisco González-Vílchez, Luis Almenar-Bonet, María Dolores García-Cosío Carmena, José González-Costello, Manuel Gómez-Bueno, María Ángeles Castel-Lavilla, Beatriz Díaz-Molina, Manuel Martínez-Sellés, Sonia Mirabet-Pérez, Luis De La Fuente-Galán, Daniela Hervás-Sotomayor, Diego Rangel-Sousa, Iris P Garrido-Bravo, Teresa Blasco-Peiró, Gregorio Rábago Juan-Aracil, Javier Muñiz, María G Crespo-Leiro","doi":"10.1016/j.rec.2024.09.005","DOIUrl":null,"url":null,"abstract":"Introduction and objectives: The impact of preoperative left ventricular (LV) unloading on postoperative outcomes in patients bridged with venoarterial extracorporeal membrane oxygenation (VA-ECMO) to heart transplantation (HT) is unknown. Our aim was to compare posttransplant outcomes in patients bridged to HT with VA-ECMO, with or without the use of different mechanical strategies for LV decompression.Methods: We conducted a retrospective analysis of the postoperative outcomes of consecutive HT candidates bridged with VA-ECMO, with or without concomitant LV unloading. Patients were included from 16 Spanish centers from 2010 to 2020. The primary endpoint was 1-year post-HT survival, which was assessed using Cox regression.Results: Overall, 245 patients underwent high-emergency HT while supported with VA-ECMO. A mechanical strategy for LV unloading was used in 133 (54.3%) patients, with the intra-aortic balloon pump being the most commonly used method (n = 112; 84.2%). One-year posttransplant survival was 74.4% in the LV unloading group and 59.8% in the control group (P = .025). In multivariate analyses, preoperative LV unloading was independently associated with lower 1-year mortality (adjusted HR, 0.50; 95%CI, 0.32-0.78; P = .003). This association was observed both in patients managed with an intra-aortic balloon pump alone (adjusted HR, 0.52; 95%CI, 0.32-0.84; P = .007) and with other strategies for mechanical LV unloading (adjusted HR, 0.43; 95%CI, 0.19-0.97; P = .042). No significant differences were found between groups regarding other postoperative complications.Conclusions: Preoperative LV unloading was independently associated with increased 1-year posttransplant survival in candidates bridged with VA-ECMO.","PeriodicalId":38430,"journal":{"name":"Revista española de cardiología (English ed.)","volume":null,"pages":null},"PeriodicalIF":7.2000,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista española de cardiología (English ed.)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.rec.2024.09.005","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction and objectives: The impact of preoperative left ventricular (LV) unloading on postoperative outcomes in patients bridged with venoarterial extracorporeal membrane oxygenation (VA-ECMO) to heart transplantation (HT) is unknown. Our aim was to compare posttransplant outcomes in patients bridged to HT with VA-ECMO, with or without the use of different mechanical strategies for LV decompression.

Methods: We conducted a retrospective analysis of the postoperative outcomes of consecutive HT candidates bridged with VA-ECMO, with or without concomitant LV unloading. Patients were included from 16 Spanish centers from 2010 to 2020. The primary endpoint was 1-year post-HT survival, which was assessed using Cox regression.

Results: Overall, 245 patients underwent high-emergency HT while supported with VA-ECMO. A mechanical strategy for LV unloading was used in 133 (54.3%) patients, with the intra-aortic balloon pump being the most commonly used method (n = 112; 84.2%). One-year posttransplant survival was 74.4% in the LV unloading group and 59.8% in the control group (P = .025). In multivariate analyses, preoperative LV unloading was independently associated with lower 1-year mortality (adjusted HR, 0.50; 95%CI, 0.32-0.78; P = .003). This association was observed both in patients managed with an intra-aortic balloon pump alone (adjusted HR, 0.52; 95%CI, 0.32-0.84; P = .007) and with other strategies for mechanical LV unloading (adjusted HR, 0.43; 95%CI, 0.19-0.97; P = .042). No significant differences were found between groups regarding other postoperative complications.

Conclusions: Preoperative LV unloading was independently associated with increased 1-year posttransplant survival in candidates bridged with VA-ECMO.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

左心室卸载对使用 VA-ECMO 桥接的心脏移植术后患者预后的影响。

简介和目的：术前左心室（LV）减压对经静脉体外膜肺氧合（VA-ECMO）桥接至心脏移植（HT）患者术后结果的影响尚不清楚。我们的目的是比较使用体外膜肺氧合（VA-ECMO）桥接至心脏移植（HT）的患者在使用或不使用不同机械策略为左心室减压的情况下的移植后预后：我们对使用 VA-ECMO 进行桥接的连续 HT 候选患者的术后效果进行了回顾性分析，无论是否同时进行左心室减压。患者来自 2010 年至 2020 年的 16 个西班牙中心。主要终点是HT术后1年生存率，采用Cox回归法进行评估：结果：共有 245 名患者在 VA-ECMO 支持下接受了高危 HT。133名患者（54.3%）采用了左心室机械减压策略，其中主动脉内球囊泵是最常用的方法（n = 112；84.2%）。左心室减压组移植后一年存活率为74.4%，对照组为59.8%（P = 0.025）。在多变量分析中，术前左心室卸载与较低的 1 年死亡率独立相关（调整后 HR，0.50；95%CI，0.32-0.78；P = .003）。在仅使用主动脉内球囊泵（调整后HR，0.52；95%CI，0.32-0.84；P = .007）和使用其他机械左心室减压策略（调整后HR，0.43；95%CI，0.19-0.97；P = .042）的患者中均可观察到这种相关性。在其他术后并发症方面，组间无明显差异：结论：在使用VA-ECMO进行桥接的患者中，术前左心室减压与移植后1年存活率的提高密切相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊