Advanced heart failure in critical patients (INTERMACS 1 and 2 levels): ventricular assist devices or emergency transplantation?

Attisani, Matteo; Centofanti, Paolo; Torre, Michele La; Boffini, Massimo; Ricci, Davide; Ribezzo, M.; Baronetto, Andrea; Rinaldi, Mauro

doi:10.1093/icvts/ivs256

Cited by 21 publications

(12 citation statements)

References 12 publications

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“…17 Moreover, in a recent singlecenter study, patients with profiles 1 and 2 who underwent VAD implantation as a bridge to HT had a significantly higher survival than those primarily listed for emergency HT. 21 In Spain, the use of MCS as a bridge to HT has been historically very infrequent, and almost restricted to temporary devices. Currently, this reality is changing, both in view of the unsatisfactory results of the previous strategy and also conditioned by a new scenario of increasing scarcity of donors and waiting list times.…”

Section: Discussionmentioning

confidence: 99%

Preoperative INTERMACS Profiles Determine Postoperative Outcomes in Critically Ill Patients Undergoing Emergency Heart Transplantation

Barge‐Caballero

Segovia‐Cubero

Almenar‐Bonet

et al. 2013

Circ: Heart Failure

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Background— Postoperative outcomes of patients with advanced heart failure undergoing ventricular assist device implantation are strongly influenced by their preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles. We sought to investigate whether a similar association exists in patients undergoing emergency heart transplantation. Methods and Results— By means of the Spanish National Heart Transplant Registry database, we identified 704 adult patients treated with emergency heart transplantation in 15 Spanish centers between 2000 and 2009. Post-transplant outcomes were analyzed pertaining to patient preoperative INTERMACS profiles, which were retrospectively assigned by 2 blinded cardiologists. Before transplantation, INTERMACS profile 1 (critical cardiogenic shock) was present in 207 patients, INTERMACS profile 2 (progressive decline) in 291, INTERMACS profile 3 (inotropic dependence) in 176, and INTERMACS profile 4 (resting symptoms) was present in 30 patients. In-hospital postoperative mortality rates were, respectively, 43%, 26.8%, and 18% in patients with profiles 1, 2, and 3 to 4 ( P <0.001). INTERMACS 1 patients also presented the highest incidence of primary graft failure (1: 31.3%, 2: 22.3%, 3–4: 21.8%; P =0.03) and postoperative need for dialysis (1: 33.2%, 2: 18.9%, 3–4: 21.5%; P <0.001). Adjusted odds-ratios for in-hospital postoperative mortality were 4.38 (95% confidence interval, 2.51–7.66) for profile 1 versus 3 to 4, 2.49 (95% confidence interval, 1.56–3.97) for profile 1 versus 2, and 1.76 (95% confidence interval, 1.02–3.03) for profile 2 versus 3 to 4. Long-term survival after hospital discharge was not influenced by preoperative INTERMACS profiles. Conclusions— Preoperative INTERMACS profiles determine outcomes after emergency heart transplantation. Results call for a change in policies related to the management of heart transplant candidates presenting with INTERMACS profiles 1 and 2.

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Section: Discussionmentioning

confidence: 99%

Preoperative INTERMACS Profiles Determine Postoperative Outcomes in Critically Ill Patients Undergoing Emergency Heart Transplantation

Barge‐Caballero

Segovia‐Cubero

Almenar‐Bonet

et al. 2013

Circ: Heart Failure

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“…After removal of duplicates, we assess for eligibility 2,849 studies. We excluded 2,809 studies based on their title and abstract and 40 articles were retrieved for full-text review, before resulting in the eight eligible studies (11)(12)(13)(14)(15)(16)(17)(18). The detailed flow diagram is presented in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…There is only one observational study (Attisani et al) that supports a HTx superiority for in-hospital mortality (14). This last study compared patients on the waiting list for HTx with urgent conditions and patients managed with LVAD as a BTT.…”

Section: Discussionmentioning

confidence: 99%

Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis

Theochari¹,

Michalopoulos²,

Oikonomou³

et al. 2018

Ann. Cardiothorac. Surg.

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Background: The optimal treatment for advanced heart failure (HF) patients with regards to mortality remains unknown. Heart transplantation (HTx) and left ventricular assist devices (LVAD) used either as a bridge to transplant (BTT) or destination therapy (DT) have been compared in a number of studies, without definite conclusions with regards to mortality benefit. We sought to systematically review the pertinent literature and perform a meta-analysis of all the available studies presenting head-to-head comparisons between HTx and LVAD BTT or LVAD DT for late (>6 months) all-cause mortality.Methods: We performed a systematic search of Medline and Cochrane Central databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a meta-analysis of late mortality comparing HTx vs. BTT LVAD and HTx vs. DT LVAD using a random effects model.Results: Eight studies were included in our meta-analysis, reporting data on 7,957 patients in total.Although the available studies are of high quality [8 stars in Newcastle-Ottawa Scale (NOS) on average], there is paucity of mortality data. Specifically, seven studies compared HTx with BTT and five studies compared HTx with DT for 1-year mortality. Our pooled estimates showed that there was no difference in late mortality among these strategies. Conclusions:Our meta-analysis highlights the small number and the heterogeneity of available studies referring to the optimal invasive management of advanced HF, and shows that there are no differences between HTx and LVAD for these patients with regards to late mortality.

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“…1 Moreover INTERMACS profile 1 and 2 patients have poorer survival than those who are less ill at the time of LVAD implantation, and have prolonged lengths of stay after LVAD implantation. 2 Thus the success of a transplantation or MCS program depends as much on appropriate patient selection as it does on the technology implanted and the perioperative and long-term clinical management.…”

Section: Clinical Impact and Future Perspectivesmentioning

confidence: 99%

Clinical Assessment of Hypoperfusion in Acute Heart Failure

Frea

Pidello

Canavosio

et al. 2015

Circ J

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Advanced heart failure in critical patients (INTERMACS 1 and 2 levels): ventricular assist devices or emergency transplantation?

Abstract: Improved outcomes may justify the use of mechanical assistance devices as a bridge to candidacy or bridge to transplantation in INTERMACS 1 and 2 patients in order to avoid high-risk transplants. Evaluation of long-term multicentre outcomes is needed to assess future strategies.

Cited by 21 publications

References 12 publications

Preoperative INTERMACS Profiles Determine Postoperative Outcomes in Critically Ill Patients Undergoing Emergency Heart Transplantation

Preoperative INTERMACS Profiles Determine Postoperative Outcomes in Critically Ill Patients Undergoing Emergency Heart Transplantation

Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis

Clinical Assessment of Hypoperfusion in Acute Heart Failure

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