ECMO as a Bridge to Left Ventricular Assist Device or Heart Transplantation

DeFilippis, Ersilia M.; Clerkin, Kevin J.; Truby, Lauren K.; Francke, Michael; Fried, Justin; Masoumi, Amirali; Garan, A.R.; Farr, Maryjane; Takayama, Hiroo; Takeda, Koji; Uriel, Nir; Topkara, V.K.

doi:10.1016/j.jchf.2020.12.012

Cited by 41 publications

(46 citation statements)

References 15 publications

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“…However, simple dichotomous categorization alone may not be the best approach in all situations, and the risk score may also be utilized as a continuous variable to make individualized decisions. In patients considered too high risk for heart transplantation, a durable mechanical support device remains a viable option 18,19 …”

Section: Discussionmentioning

confidence: 99%

Outcomes of diabetic patients with end‐stage heart failure listed for heart transplantation: A propensity‐matched analysis

Akintoye

Álvarez

Salih

et al. 2022

Clinical Transplantation

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Background:We investigated the current trends and outcomes of diabetic patients listed for heart transplants in the U.S. and provided a method for risk-stratification. Methods:Using data from the United Network for Organ Sharing (UNOS), we identified heart failure patients listed for heart transplants between 2010 and 2019. Diabetic patients were propensity-matched with non-diabetics, and waitlist mortality as well as post-transplant graft survival were compared between the two groups. Further risk-stratification of diabetic patients was done based on the risk factors that independently predict graft failure.Results: 28,928 adult patients (30% diabetic) with end-stage heart failure were added to the waitlist over the study period. In the propensity-matched cohort, waitlist mortality was higher in diabetic patients compared to non-diabetics (HR = 1.13 (95% CI = 1.04-1.22, P = .002). Over the study period, 5739 patients with diabetes were transplanted. In the propensity-matched cohorts of transplant recipients, the rate of graft failure was significantly higher for diabetic patients (23.3%) compared to nondiabetics (20.4%); HR = 1.17, 95% CI = 1.08-1.26, P < .001. We identified 12 risk factors of graft failure among diabetic patients and developed a risk score that further risk-stratify these patients. Diabetic patients at low risk (score≤4) had similar graft survival as patients without diabetes (HR = .91, 95% CI = .82-1.01, P = .06). On the other hand, high-risk diabetic patients had worse graft survival compared to non-diabetics

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Section: Discussionmentioning

confidence: 99%

Outcomes of diabetic patients with end‐stage heart failure listed for heart transplantation: A propensity‐matched analysis

Akintoye

Álvarez

Salih

et al. 2022

Clinical Transplantation

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“…In an analysis by DeFilippis et al of 906 patients receiving ECMO, there was no difference in mortality between 587 patients bridged to LVAD and 319 patients receiving a donor heart. The authors concluded that bridging with LVAD was non-inferior to transplantation in VA-ECMO patients [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-Up

et al. 2021

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Background and Objectives: Over the past decade, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has developed into a mainstream treatment for refractory cardiogenic shock (CS) to maximal conservative management. Successful weaning of VA-ECMO may not be possible, and bridging with further mechanical circulatory support (MCS), such as urgent implantation of a left ventricular assist device (LVAD), may represent the only means to sustain the patient haemodynamically. In the recovery phase, many survivors are not suitably prepared physically or psychologically for the novel issues encountered during daily life with an LVAD. Materials and Methods: A retrospective analysis of our institutional database between 2012 and 2019 was performed to identify patients treated with VA-ECMO for CS who underwent urgent LVAD implantation whilst on MCS. Post-cardiotomy cases were excluded. QoL was assessed prospectively during a routine follow-up visit using the EuroQol-5 dimensions-5 level (EQ-5D-5L) and the Patient Health Questionnaire (PHQ-9) surveys. Results: Among 126 in-hospital survivors of VA-ECMO therapy due to cardiogenic shock without prior cardiac surgery, 31 (24.6%) urgent LVAD recipients were identified. In 11 (36.7%) cases, cardiopulmonary resuscitation (CPR) was performed (median 10, range 1–60 min) before initiation of VA-ECMO, and in 5 (16.7%) cases, MCS was established under CPR. Mean age at LVAD implantation was 51.7 (+/−14) years and surgery was performed after a mean 12.1 (+/−8) days of VA-ECMO support. During follow-up of 46.9 (+/−25.5) months, there were 10 deaths after 20.4 (+/−12.1) months of LVAD support. Analysis of QoL questionnaires returned a mean EQ-5D-5L score of 66% (+/−21) of societal valuation for Germany and a mean PHQ-9 score of 5.7 (+/−5) corresponding to mild depression severity. When compared with 49 elective LVAD recipients without prior VA-ECMO therapy, there was no significant difference in QoL results. Conclusions: Patients requiring urgent LVAD implantation under VA-ECMO support due to CS are associated with comparable quality of life without a significant difference from elective LVAD recipients. Close follow-up is required to oversee patient rehabilitation after successful initial treatment.

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“…102 ECMO as a strategy of bridge to LVAD is associated with worse odds of survival and increased need for biventricular support compared to IABP and other tMCS, 103 yet importantly, bridging from ECMO to VAD has survival rates equivalent as bridging from ECMO to HT. 104…”

Section: Venoarterial Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

Heart Failure-Related Cardiogenic Shock: Pathophysiology, Evaluation and Management Considerations

Abraham

Blumer

Burkhoff

et al. 2021

Journal of Cardiac Failure

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ECMO as a Bridge to Left Ventricular Assist Device or Heart Transplantation

Cited by 41 publications

References 15 publications

Outcomes of diabetic patients with end‐stage heart failure listed for heart transplantation: A propensity‐matched analysis

Outcomes of diabetic patients with end‐stage heart failure listed for heart transplantation: A propensity‐matched analysis

Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-Up

Heart Failure-Related Cardiogenic Shock: Pathophysiology, Evaluation and Management Considerations

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