Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
Expert Rev Med Devices. 2023 Jun;20(6):449-457. doi: 10.1080/17434440.2023.2206562. Epub 2023 Apr 26.
Many patients listed for transplant require temporary or durable mechanical circulatory support (MCS) devices for bridging to cardiac transplantation. The choice of device for bridging to heart depends on a number of factors including level of support desired and patient-device hemocompatibility.
The authors summarize the current heart transplant landscape including the new UNOS listing criteria as well as indications for bridging to transplant with MCS devices. The authors also review the characteristics of commonly used MCS devices and discuss the limited evidence supporting their use in cardiogenic shock and specifically as a bridge to heart transplant.
The new UNOS heart organ allocation policy has resulted in a growth in the use of temporary MCS devices as bridge to transplantation for patients with cardiogenic shock, while bridging with durable MCS devices has become more challenging. Patients supported on temporary MCS devices should be routinely assessed for potential of myocardial recovery prior to urgent transplantation. Emerging machine learning algorithms may help better identify individuals who are likely to recover on temporary or durable MCS therapy. Modifications to the current heart allocation policy may facilitate bridging of patients with durable left ventricular assist devices.
许多接受移植的患者需要临时或永久性机械循环支持（MCS）设备来桥接心脏移植。桥接心脏的设备选择取决于许多因素，包括所需的支持水平和患者-设备的血液相容性。
作者总结了当前心脏移植的现状，包括新的 UNOS 列出的标准以及使用 MCS 设备桥接移植的适应症。作者还回顾了常用 MCS 设备的特点，并讨论了支持它们在心源性休克中的使用的有限证据，特别是作为心脏移植的桥接。
新的 UNOS 心脏器官分配政策导致越来越多的患者使用临时 MCS 设备作为桥接移植治疗心源性休克，而使用耐用性 MCS 设备桥接则变得更加困难。在紧急移植前，应常规评估接受临时 MCS 设备支持的患者是否有可能恢复心肌功能。新兴的机器学习算法可能有助于更好地识别可能从临时或耐用性 MCS 治疗中恢复的个体。对当前心脏分配政策的修改可能有助于桥接耐用性左心室辅助装置的患者。
