Zhou Alice L, Etchill Eric W, Shou Benjamin L, Whitbread James J, Barbur Iulia, Giuliano Katherine A, Kilic Ahmet
Johns Hopkins University School of Medicine, Baltimore, Md.
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
JTCVS Open. 2022 Sep 8;12:255-268. doi: 10.1016/j.xjon.2022.08.011. eCollection 2022 Dec.
We compared posttransplant outcomes between patients bridged from temporary mechanical circulatory support to durable left ventricular assist device before transplant (bridge-to-bridge [BTB] strategy) and patients bridged from temporary mechanical circulatory support directly to transplant (bridge-to-transplant [BTT] strategy).
We identified adult heart transplant recipients in the Organ Procurement and Transplantation Network database between 2005 and 2020 who were supported with extracorporeal membrane oxygenation, intra-aortic balloon pump, or temporary ventricular assist device as a BTB or BTT strategy. Kaplan-Meier survival analysis and Cox regressions were used to assess 1-year, 5-year, and 10-year survival. Posttransplant length of stay and complications were compared as secondary outcomes.
In total, 201 extracorporeal membrane oxygenation (61 BTB, 140 BTT), 1385 intra-aortic balloon pump (460 BTB, 925 BTT), and 234 temporary ventricular assist device (75 BTB, 159 BTT) patients were identified. For patients supported with extracorporeal membrane oxygenation, intra-aortic balloon pump, or temporary ventricular assist device, there were no differences in survival between BTB and BTT at 1 and 5 years posttransplant, as well as 10 years posttransplant even after adjusting for baseline characteristics. The extracorporeal membrane oxygenation BTB group had greater rates of acute rejection (32.8% vs 13.6%; = .002) and lower rates of dialysis (1.6% vs 21.4%; < .001). For intra-aortic balloon pump and temporary ventricular assist device patients, there were no differences in posttransplant length of stay, acute rejection, airway compromise, stroke, dialysis, or pacemaker insertion between BTB and BTT recipients.
BTB patients have similar short- and midterm posttransplant survival as BTT patients. Future studies should continue to investigate the tradeoff between prolonged temporary mechanical circulatory support versus transitioning to durable mechanical circulatory support.
我们比较了在移植前从临时机械循环支持过渡到持久性左心室辅助装置的患者（桥接至桥接[BTB]策略）与从临时机械循环支持直接过渡到移植的患者（桥接至移植[BTT]策略）的移植后结局。
我们在器官获取与移植网络数据库中识别出2005年至2020年间接受体外膜肺氧合、主动脉内球囊泵或临时心室辅助装置支持的成年心脏移植受者，这些支持作为BTB或BTT策略。采用Kaplan-Meier生存分析和Cox回归来评估1年、5年和10年生存率。将移植后住院时间和并发症作为次要结局进行比较。
总共识别出201例接受体外膜肺氧合的患者（61例BTB，140例BTT）、1385例接受主动脉内球囊泵的患者（460例BTB，925例BTT）和234例接受临时心室辅助装置的患者（75例BTB，159例BTT）。对于接受体外膜肺氧合、主动脉内球囊泵或临时心室辅助装置支持的患者，即使在调整基线特征后，BTB组和BTT组在移植后1年、5年以及10年的生存率也没有差异。体外膜肺氧合BTB组的急性排斥反应发生率更高（32.8%对13.6%；P = 0.002），而透析率更低（1.6%对21.4%；P < 0.001）。对于接受主动脉内球囊泵和临时心室辅助装置的患者，BTB组和BTT组在移植后住院时间、急性排斥反应、气道受压、中风、透析或起搏器植入方面没有差异。
BTB患者移植后的短期和中期生存率与BTT患者相似。未来的研究应继续探讨延长临时机械循环支持与过渡到持久性机械循环支持之间的权衡。
