Impact of Mechanical Circulatory Support on Posttransplant Outcomes

Dardas, Todd

doi:10.1016/j.ccl.2018.06.009

Cited by 9 publications

(8 citation statements)

References 46 publications

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“…Vasoplegia is reported to occur with an incidence of between 8-25% in the general cardiac surgical population, and is significantly more prevalent following HTx with an incidence as high as 54% reported (1,15). Whilst the precise mechanism for vasoplegia following cardiac surgery has yet to be fully elucidated it is believed to relate to a generalised activation of multiple vasodilatory pathways including production of nitric oxide and activation of inhibitory vascular smooth muscle ion channels, resulting in an inability to maintain vascular tone (5). The increased vasoplegia risk with HTx is thought to relate to an elevation of inflammatory cytokines (tumour necrosis factor-α and interleukin-6) that is observed in advanced heart failure, together with the enhanced systemic inflammatory response that is initiated upon reperfusion and exposure to donor antigens (2,16).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have demonstrated durable continuous-flow left ventricular assist device (CF-LVAD) to be an independent predictor for the development of vasoplegia (3)(4)(5)(6)(7). These studies have reported that vasoplegia is associated with inferior outcomes following HTx, including decreased survival.…”

Section: Original Articlementioning

confidence: 99%

“…With the evolution of LVAD technology and the improved survival and quality of life observed, there has been an increase in use of durable LVADs as a bridge to transplantation (5). This will result in more patients undergoing HTx with a durable LVAD.…”

Section: Original Articlementioning

confidence: 99%

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Vasoplegia following heart transplantation and left ventricular assist device explant is not associated with inferior outcomes

et al. 2020

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Background: Vasoplegia has been associated with inferior outcomes following heart transplantation (HTx).This observational study was designed to investigate outcomes in recipients with vasoplegia following left ventricular assist device (LVAD) explant HTx. Methods: Patients undergoing LVAD explant followed by HTx from 01/2013-12/2018 at our centre were included. Vasoplegia was defined as the requirement for high dose vasopressor [noradrenaline (>0.5 μg/kg/min) and vasopressin (>1 U/h)] over the first 24 hours following HTx. Demographic and outcome data were retrieved from the transplant unit database. Results: During the study period 24 patients underwent LVAD explant HTx. Of these, 13 (54.2%) developed vasoplegia. Both groups had similar duration of LVAD support (median 684 vs. 620 days P=0.62).There was a higher incidence of driveline infection in patients developing vasoplegia (69.2% vs. 18.2% P=0.02). HTx following donation after circulatory death (DCD) occurred in 9 (37.5%) patients and was not associated with a higher incidence of vasoplegia (P=0.21). Vasoplegia developed early following reperfusion and intensive care unit admission vasopressor-inotrope scores were significantly higher in patients with vasoplegia (P=0.002). Patients developing vasoplegia had similar ICU (P=0.79) and hospital (P=0.93) lengths of stay. Survival was equivalent both at 30-day (92.3% vs. 100% P=0.99) and 1-year (67.7% vs. 74.7% P=0.70). Our overall HTx 1-year survival was 89.3% over this period. Conclusions: Vasoplegia is seen with a high incidence in HTx recipients bridged with an LVAD. This appears to be associated with the presence of driveline infections. Early aggressive management is advocated, resulting in equivalent 1-year survival to those patients not developing vasoplegia.

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Section: Discussionmentioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

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Vasoplegia following heart transplantation and left ventricular assist device explant is not associated with inferior outcomes

et al. 2020

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“…In addition, the IABP and TAH, as used in his treatment, are mechanical options that can provide conceptually similar bridge-to-transplantation support, although both are associated with considerable morbidity rates during the waiting period. [12][13][14] The TAH, which was used in a heroic and still-experimental fashion in his case, can provide total circulatory support; however, its placement can be complicated in the presence of aberrant anatomy such as a dominant heterotopic cardiac graft.…”

Section: Discussionmentioning

confidence: 99%

The Man with 2 Hearts: 25 Years from Heterotopic to Orthotopic Heart Transplantation

Godfrey

Kueht

Rana

et al. 2019

Texas Heart Institute Journal

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Substantial technological advances in mechanical circulatory support have caused a shift in the management of end-stage heart failure. From the 1970s through the 1990s, heterotopic heart transplantation was routinely performed in patients in whom orthotopic transplantation was likely to fail. Heterotopic heart transplantation is now performed less often because modern mechanical circulatory assist devices are routinely used as bridges to orthotopic transplantation; regardless, the operation has helped numerous patients who would not otherwise have received adequate allografts. We describe the case of a man with idiopathic nonischemic cardiomyopathy who, at age 17, was given an ABO- and size-matched heterotopic allograft that was a complete human leukocyte antigen mismatch. The graft functioned normally for 20 years until the patient had a myocardial infarction that necessitated placement of a coronary artery stent. Subsequent treatments involved many interventions, including insertion of an intra-aortic balloon pump, medical therapy for heart failure, implantation of a total artificial heart, and, ultimately, orthotopic transplantation. To our knowledge, our patient is the longest surviving recipient of a heterotopic heart transplant, with a remarkable 25-year graft survival despite poor histocompatibility and an almost complete lack of native heart function. The strategies used for his treatment make him a living case study that can add valuable information to the history of cardiac support.

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“…Another key issue of utilizing the LVAD as a bridge to transplantation is to get to the heart transplant prior to the onset of device-related complications, such as infection, bleeding, or thromboembolic events as described (Steffen et al 2017;Wever-Pinzon et al 2013;Dardas 2018). With the newly implemented heart allocation system in October of 2018, patients with durable LVADs are experiencing longer wait times, which therefore increases the risk of developing a complication.…”

Section: Hf Disease Severitymentioning

confidence: 99%

Ventricular Assist Device as Bridge-to-Transplant

Nguyen¹,

Li²

2020

Organ and Tissue Transplantation

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Due to the limited donor supply and long wait times for heart transplantation, the use of a ventricular assist device as a bridge to heart transplantation is increasing. With the development of the continuous flow device, there has been improved mechanical durability with a resultant decrease in waitlist mortality for patient who are waiting for heart transplantation. When selecting patients for potential assist device therapy, it is important to consider heart failure severity for timing of device implantation, right ventricular function, and ability to tolerate anticoagulation.

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Impact of Mechanical Circulatory Support on Posttransplant Outcomes

Cited by 9 publications

References 46 publications

Vasoplegia following heart transplantation and left ventricular assist device explant is not associated with inferior outcomes

Vasoplegia following heart transplantation and left ventricular assist device explant is not associated with inferior outcomes

The Man with 2 Hearts: 25 Years from Heterotopic to Orthotopic Heart Transplantation

Ventricular Assist Device as Bridge-to-Transplant

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