One-year before and after UNOS Status Change Effect on ECMO as a Bridge to Heart Transplant

Abstract

months, 336 patients were included. Patients with history of DM and/or pre-LVAD HbA1c ≥6.5 comprised the DM group (n=142), while those with no history of DM and a pre-LVAD HbA1c <6.5 comprised the non-DM group (n=194). Diabetics with a pre-LVAD HbA1c <7 were considered well-controlled (n=72) and those with a pre-LVAD HbA1c ≥7 not well-controlled (n=70). Relative changes between pre-and post-LVAD LVEF and LVEDD, were calculated. Cardiac recovery was defined as post-LVAD LVEF ≥40% and LVEDD <6.0cm. Results: Baseline characteristics of the 2 groups are shown in the Table . Cardiac functional and structural improvement, as evidenced by relative LVEF and LVEDD changes, was more prominent in non-DM compared to DM patients, and in well-compared to not well-controlled DM patients (Figure). Overall, DM patients were less likely to experience cardiac recovery (8.4% vs 17.5%; p=0.032), while on LVAD support. This remained significant in a multivariate logistic regression after controlling for potential confounders. Conclusion:The presence of DM, and notably not well-controlled DM, appears to negatively affect the potential for LVAD-induced myocardial recovery. Further research is needed to investigate the dynamic cardiac metabolism in HF with DM.

Mechanical Circulatory Support: Individualizing the Complexity of Care

“…When the transplant allocation rules and regulations changed in October 2018, so did the strategies for bridging individuals to a long-term and more durable device. 1 Because of this allocation policy change, the use of ambulatory ECMO increased 5-fold, leading to a need for knowledge to care for these patients appropriately. 1 This article provides information on the evolution of ambulatory ECMO use as a leading therapy for critically ill cardiogenic shock patients.…”

“…1 Because of this allocation policy change, the use of ambulatory ECMO increased 5-fold, leading to a need for knowledge to care for these patients appropriately. 1 This article provides information on the evolution of ambulatory ECMO use as a leading therapy for critically ill cardiogenic shock patients. The COVID-19 pandemic in 2020 showed that ECMO consideration was needed more than ever for these extremely ill patients.…”