HF and is considered one of key contraindications to orthotopic heart transplant (OHT). 2,9 Reversing increased pulmonary capillary pressure represents a therapeutic challenge, which would make OHT-a final resolution of congestive HF-possible. There have been few studies that analyzed the impact of CF-LVAD implantation on pulmonary pressure and resistance. Some authors INTRODUCTION A constant increase in the number of patients with end-stage heart failure (HF) and a shortage of heart donors worldwide implies a wider use of mechanical circulatory support, mainly continuous-flow left ventricular assist devices (CF-LVADs).
Purpose: Early graft dysfunction (EGD) is a major cause of morbidity and mortality following heart transplantation (HT). Severe EGD often includes the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Studies evaluating its effectiveness are mostly single centre observations with variable outcomes. This systematic review and metaanalysis appraises the available evidence and evaluates prognosis in HT patients with EGD requiring VA-ECMO. Methods: We conducted a systematic search of Ovid Medline, Embase and the Cochrane databases to 05/15/2020. Studies of adults who received VA-ECMO during their index hospitalization after HT and reported on mortality at any timepoint were included. We included observational studies published after 2009, in any language, as abstracts or full texts. Outcomes of interest were short-term mortality, 1-year mortality and VA-ECMO complications. We used QUIPS to assess risk of bias and GRADE to assess the quality of the evidence. Data was pooled using random-effects models. Results: We included 50 studies of 1472 patients with 504 short-term mortality events. Most studies were retrospective (94%), single centre (88%), and at low/acceptable risk of bias overall (76%). Pooled short-term mortality was 33% (95%CI: 27-38%, I 2 =76%) and 1-year mortality was 46% (95%CI: 37-54%, I 2 =81%). Risk of bias, publication type, recruitment timeframe, and use of VA-ECMO for only primary graft dysfunction as per the ISHLT definition did not explain heterogeneity in subgroup analyses. Reported VA-ECMO complications were 38% (95%CI: 27-49%) for dialysis, 36% (95%CI: 26-47%) for bleeding, 22% (95%CI: 14-31%) for infection and 5% (95%CI: 1-10%) for limb ischemia. Conclusion: One-third of HT patients with EGD supported with VA-ECMO are at risk of short-term death. An individual patient data metaanalysis is warranted to further understand the mortality risk and gain insight into risk factors associated with outcomes in this population.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.