Contemporary Bridge to Heart Transplantation With Venoarterial Extracorporeal Membrane Oxygenation.

Omar M Sharaf, Ryan Azarrafiy, Jeffrey P Jacobs, Giles J Peek, Mustafa M Ahmed, Alex Parker, Mohammad A Al-Ani, Feriel Esseghir, Juan Vilaro, Juan Aranda, Ahmet Bilgili, Mark S Bleiweis, Eric I Jeng
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Abstract

Objective: In October 2018, the United Network for Organ Sharing changed their heart allocation criteria to prioritize patients on temporary mechanical circulatory support. This study assesses outcomes of patients bridged to orthotopic heart transplantation (OHT) with venoarterial extracorporeal membrane oxygenation (VA ECMO) since this change. Methods: We conducted a retrospective single-center study of adults (≥18 years) supported with VA ECMO at the time of OHT (October 1, 2018, to December 31, 2021). The primary outcome was midterm survival. Results: During the study period, 117 patients underwent OHT including 52 adults ≥18 years (44%) and 65 children <18 years (56%). Among adults, 8 (15%) were supported with VA ECMO at the time of OHT and are included in this study; 75% were male (n = 6), and the median age was 52.5 (interquartile range [IQR] = 23.5 to 57.25) years. Most patients were peripherally cannulated (75%, n = 6) and supported with an intra-aortic balloon pump during the pretransplant period (87.5%, n = 7). The median ECMO duration was 7 (IQR = 4.5 to 25.25) days. Three patients experienced complications on ECMO (37.5%), including thromboembolic bowel infarction (12.5%, n = 1) and bleeding requiring reintervention (25%, n = 2). All patients survived to discharge without posttransplantation complications and were alive at the latest follow-up. The median follow-up time was 24.8 (IQR = 19.5 to 28.2) months. Conclusions: Patients can be successfully bridged with VA ECMO directly to OHT with excellent midterm results. Key contributors to our outcomes include early extubation, use of bivalirudin over heparin, ambulation, and rehabilitation while on ECMO.

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利用静脉体外膜氧合技术实现心脏移植的当代桥梁
目的:2018 年 10 月,器官共享联合网络(United Network for Organ Sharing)改变了心脏分配标准,优先考虑接受临时机械循环支持的患者。本研究评估了自这一变化以来,通过静脉体外膜氧合(VA ECMO)桥接至正位心脏移植(OHT)患者的预后。方法:我们对OHT时(2018年10月1日至2021年12月31日)接受VA ECMO支持的成人(≥18岁)进行了一项回顾性单中心研究。主要结果是中期存活率。研究结果在研究期间,117 名患者接受了 OHT,其中包括 52 名≥18 岁的成人(44%)和 65 名儿童(n = 6),中位年龄为 52.5 岁(四分位距[IQR] = 23.5 至 57.25)。大多数患者在移植前都进行了外周插管(75%,n = 6),并使用主动脉内球囊泵支持(87.5%,n = 7)。ECMO 中位持续时间为 7 天(IQR = 4.5 至 25.25)。三名患者在 ECMO 期间出现并发症(37.5%),包括血栓栓塞性肠梗死(12.5%,n = 1)和需要再次介入的出血(25%,n = 2)。所有患者均顺利出院,未出现移植后并发症,最近一次随访时均健在。中位随访时间为 24.8 个月(IQR = 19.5 至 28.2 个月)。结论:患者可以通过 VA ECMO 成功地直接过渡到 OHT,并取得良好的中期效果。早期拔管、使用比伐卢定而非肝素、行走以及在 ECMO 期间进行康复训练是取得疗效的关键因素。
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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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