Clinical Outcomes of Cardiac Transplantation in Heart Failure Patients with Previous Mechanical Cardiocirculatory Support.

IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Journal of Clinical Medicine Pub Date : 2025-01-06 DOI:10.3390/jcm14010275
Michele D'Alonzo, Amedeo Terzi, Massimo Baudo, Mauro Ronzoni, Nicola Uricchio, Claudio Muneretto, Lorenzo Di Bacco
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Abstract

Objectives: Heart failure (HF) remains a significant public health issue, with heart transplantation (HT) being the gold standard treatment for end-stage HF. The increasing use of mechanical circulatory support, particularly left ventricular assist devices (LVADs), as a bridge to transplant (BTT), presents new perspectives for increasingly complex clinical scenarios. This study aimed to compare long-term clinical outcomes in patients in heart failure with reduced ejection fraction (HFrEF) receiving an LVAD as BTT to those undergoing direct-to-transplant (DTT) without mechanical support, focusing on survival and post-transplant complications. Methods: A retrospective, single-center study included 105 patients who underwent HT from 2010. Patients were divided into two groups: BTT (n = 28) and DTT (n = 77). Primary endpoints included overall survival at 1 and 7 years post-HT. Secondary outcomes involved late complications, including organ rejection, renal failure, cardiac allograft vasculopathy (CAV), and cerebrovascular events. Results: At HT, the use of LVADs results in longer cardiopulmonary bypass and cross-clamping times in the BTT group; nevertheless, surgical complexity does not affect 30-day mortality. Survival at 1 year was 89.3% for BTT and 85.7% for DTT (p = 0.745), while at 7 years, it was 80.8% and 77.1%, respectively (p = 0.840). No significant differences were observed in the incidence of major complications, including permanent dialysis, organ rejection, and CAV. However, a higher incidence of cerebrovascular events was noted in the BTT group (10.7% vs. 2.6%). Conclusions: LVAD use as BTT does not negatively impact early post-transplant survival compared to DTT. At long-term follow-up, clinical outcomes remained similar across groups, supporting LVADs as a viable option for bridging patients to transplant.

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来源期刊
Journal of Clinical Medicine
Journal of Clinical Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
5.70
自引率
7.70%
发文量
6468
审稿时长
16.32 days
期刊介绍: Journal of Clinical Medicine (ISSN 2077-0383), is an international scientific open access journal, providing a platform for advances in health care/clinical practices, the study of direct observation of patients and general medical research. This multi-disciplinary journal is aimed at a wide audience of medical researchers and healthcare professionals. Unique features of this journal: manuscripts regarding original research and ideas will be particularly welcomed.JCM also accepts reviews, communications, and short notes. There is no limit to publication length: our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible.
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