Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Eur J Heart Fail. 2018 Jan;20(1):178-186. doi: 10.1002/ejhf.956. Epub 2017 Sep 26.
In Spain, listing for high-urgent heart transplantation is allowed for critically ill candidates not weanable from temporary mechanical circulatory support (T-MCS). We sought to analyse the clinical outcomes of this strategy.
We conducted a case-by-case, retrospective review of clinical records of 291 adult patients listed for high-urgent heart transplantation under temporary devices from 2010 to 2015 in 16 Spanish institutions. Survival after listing and adverse clinical events were studied. At the time of listing, 169 (58%) patients were supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO), 70 (24%) on temporary left ventricular assist devices (T-LVAD) and 52 (18%) on temporary biventricular assist devices (T-BiVAD). Seven patients transitioned from VA-ECMO to temporary ventricular assist devices while on the waiting list. Mean time on T-MCS was 13.1 ± 12.6 days. Mean time from listing to transplantation was 7.6 ± 8.5 days. Overall, 230 (79%) patients were transplanted and 54 (18.6%) died during MCS. In-hospital postoperative mortality after transplantation was 33.3%, 11.9% and 26.2% for patients bridged on VA-ECMO, T-LVAD and T-BiVAD, respectively (P = 0.008). Overall survival from listing to hospital discharge was 54.4%, 78.6% and 55.8%, respectively (P = 0.002). T-LVAD support was independently associated with a lower risk of death over the first year after listing (hazard ratio 0.52, 95% confidence interval 0.30-0.92). Patients treated with VA-ECMO showed the highest incidence rate of adverse clinical events associated with T-MCS.
Temporary devices may be used to bridge critically ill candidates directly to heart transplantation in a setting of short waiting list times, as is the case of Spain. In our series, bridging with T-LVAD was associated with more favourable outcomes than bridging with T-BiVAD or VA-ECMO.
在西班牙，对于不能脱离临时机械循环支持（T-MCS）的重症候选者，可以允许进行高紧急心脏移植。我们试图分析该策略的临床结果。
我们对 2010 年至 2015 年间在西班牙 16 家机构接受 T-MCS 临时设备治疗的 291 名成年高紧急心脏移植患者的临床记录进行了逐个、回顾性分析。研究了列表后的存活率和不良临床事件。在列表时，169 名（58％）患者接受静脉-动脉体外膜氧合（VA-ECMO）支持，70 名（24％）患者接受临时左心室辅助设备（T-LVAD）支持，52 名（18％）患者接受临时双心室辅助设备（T-BiVAD）支持。7 名患者在等待名单上从 VA-ECMO 过渡到临时心室辅助设备。T-MCS 的平均时间为 13.1±12.6 天。从列表到移植的平均时间为 7.6±8.5 天。总体而言，230 名（79％）患者接受了移植，54 名（18.6％）患者在 MCS 期间死亡。移植后住院内的术后死亡率分别为接受 VA-ECMO、T-LVAD 和 T-BiVAD 桥接的患者的 33.3％、11.9％和 26.2％（P=0.008）。从列表到出院的总体生存率分别为 54.4％、78.6％和 55.8％（P=0.002）。T-LVAD 支持与列表后第一年的死亡风险降低独立相关（风险比 0.52，95％置信区间 0.30-0.92）。接受 VA-ECMO 治疗的患者表现出与 T-MCS 相关的不良临床事件的发生率最高。
在等待时间较短的情况下，临时设备可用于将重症候选者直接桥接到心脏移植。在我们的系列中，与 T-BiVAD 或 VA-ECMO 桥接相比，T-LVAD 桥接与更有利的结果相关。
