Impact of Temporary Percutaneous Mechanical Circulatory Support Before Transplantation in the 2018 Heart Allocation System

Clerkin, Kevin J.; Salako, Oluwafeyijimi; Fried, Justin; Griffin, Jan M.; Raikhelkar, J.; Jain, Rashmi; Restaino, Susan; Colombo, P.C.; Takeda, Koji; Farr, Maryjane; Sayer, Gabriel; Uriel, Nir; Topkara, V.K.

doi:10.1016/j.jchf.2021.08.003

Cited by 25 publications

(24 citation statements)

References 12 publications

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“…113–115 However, given acuity of illness and frequent multiorgan impairment, adverse outcomes have been reported in patients bridged from tMCS such as VA-ECMO to heart transplantation or durable mechanical circulatory support. 116–118 Further research is needed to identify which patients are best suited for advanced therapies as a bridge from tMCS.…”

Section: De-escalating Tmcsmentioning

confidence: 99%

Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association

Geller¹,

Sinha²,

Kapur³

et al. 2022

Circulation

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The use of temporary mechanical circulatory support in cardiogenic shock has increased dramatically despite a lack of randomized controlled trials or evidence guiding clinical decision-making. Recommendations from professional societies on temporary mechanical circulatory support escalation and de-escalation are limited. This scientific statement provides pragmatic suggestions on temporary mechanical circulatory support device selection, escalation, and weaning strategies in patients with common cardiogenic shock causes such as acute decompensated heart failure and acute myocardial infarction. The goal of this scientific statement is to serve as a resource for clinicians making temporary mechanical circulatory support management decisions and to propose standardized approaches for their use until more robust randomized clinical data are available.

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Section: De-escalating Tmcsmentioning

confidence: 99%

Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association

Geller¹,

Sinha²,

Kapur³

et al. 2022

Circulation

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“…In specific, a better allocation of patients on a LVAD was implemented based on their dischargability which was not taken into account in the previous allocation system. Early reports evaluating the outcomes have suggested increase in transplant volume with reduced wait list mortality and no significant change in posttransplant survival 6–9 . The allocation policy change has reduced the feasibility of using LVAD as bridge to heart transplant patients (BTT) as reflected in the Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database, a national registry of patients receiving durable mechanical circulatory support devices 10 …”

Section: Introductionmentioning

confidence: 99%

“…Early reports evaluating the outcomes have suggested increase in transplant volume with reduced wait list mortality and no significant change in posttransplant survival. [6][7][8][9] The allocation policy change has reduced the feasibility of using LVAD as bridge to heart transplant patients (BTT) as reflected in the Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database, a national registry of patients receiving durable mechanical circulatory support devices. 10 The aim of this study was to evaluate the posttransplant outcomes of BTT patients stratified by changes to the heart allocation system.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and outcomes of left ventricular assist device recipients transplanted before and after the new donor heart allocation system

et al. 2022

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Background Concerns about the impact of the new donor heart allocation system on posttransplant outcomes have emerged after its implementation. We sought to evaluate the characteristics and outcomes of left ventricular assist device (LVAD) recipients transplanted before and after the implantation of the new policy on October 18, 2018. Methods Data on bridge to transplantation of adult patients with LVAD between January 2015 and October 2021, with durable LVAD as a (BTT), was queried from the United Network of Organ Sharing (UNOS) registry. The main outcomes were 30‐day all‐cause mortality, 30‐day fatal graft failure, 1‐year all‐cause mortality, treated acute rejection at 1 year and renal replacement therapy (RRT) for acute renal failure. Results In our study, 7096 patients met the inclusion criteria including 2435 in the new allocation system. The transplanted patients in the new allocation system era had older donor age, longer ischemic time, and higher proportion of newer generation LVADs. Adjusted 30‐day all‐cause mortality was significantly lower for LVAD recipients in the new allocation system era (2.5% vs. 3.6%; sub‐hazard ratio [SHR] 0.36, 95% Confidence intervals [CI] 0.27–0.48, p < 0.001) without differences in the risk of fatal graft failure and 1‐year mortality (7.8% vs. 9.6%). Significantly lower adjusted 30‐day mortality with HVAD and HM3 devices than HM2 in the new allocation system era was found, without differences in 1‐year mortality. Acute allograft rejection requiring treatment was significantly lower (Odds Ratio 0.78, 95% CI 0.65–0.94, p = 0.01), whereas a trend toward higher risk of renal failure requiring RRT was identified. Conclusions Despite changing donor characteristics and longer ischemic times, posttransplant outcomes in LVAD recipients have not worsened with the implementation of the new allocation system and this finding is related to the use of newer generation continuous flow LVADs.

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“…This has led to substantially longer time on LVAD support with a concomitant shift in patient characteristics and outcomes. Finally, changes to the United Network for Organ Sharing OHT listing criteria in 2018 and advances in the use of temporary mechanical circulatory support (MCS), have resulted in an even more significant reduction in BTT LVAD usage in the last 3 years [17].…”

Section: Contemporary Adverse Event Rates After Lvad Events Per Patie...mentioning

confidence: 99%

Recurrent Heart Failure after Left Ventricular Assist Device Placement

Alexy¹,

Burke²

2023

Ventricular Assist Devices - Advances and Applications in Heart Failure

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A host of complications are common after left ventricular assist device (LVAD) surgery. Perhaps none is more challenging to manage than recurrent heart failure (HF). HF in an LVAD patient is associated with substantial morbidity and increased mortality. HF can occur early or late, can present abruptly or insidiously, and can be due to an array of LVAD-specific problems including pump thrombosis and cannula obstruction, or intrinsic cardiac problems such as right ventricular failure or valvular disease. These disparate etiologies require specific testing and distinct therapeutic strategies. This chapter reviews the causes of recurrent HF after LVAD surgery with particular attention to evaluation and management strategies that can identify and treat these distinct etiologies.

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Impact of Temporary Percutaneous Mechanical Circulatory Support Before Transplantation in the 2018 Heart Allocation System

Cited by 25 publications

References 12 publications

Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association

Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association

Characteristics and outcomes of left ventricular assist device recipients transplanted before and after the new donor heart allocation system

Recurrent Heart Failure after Left Ventricular Assist Device Placement

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