Post-transplant outcome in patients bridged to transplant with temporary mechanical circulatory support devices

Yin, M.; Wever‐Pinzon, Omar; Mehra, Mandeep R.; Selzman, Craig H.; Toll, Alice E.; Cherikh, Wida S.; Nativi-Nicolau, José; Fang, James C.; Kfoury, Abdallah G.; Gilbert, Edward M.; Kemeyou, Line; McKellar, Stephen H.; Koliopoulou, Antigone; Vaduganathan, Muthiah; Drakos, Stavros G.; Stehlik, Josef

doi:10.1016/j.healun.2019.04.003

Cited by 92 publications

(106 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19 As already observed in previous work, 17 the cost of HT in our center is lower than that reported by centers in the United States (US), which place it at around $150 000 11 -similar to that of some European centers. Moreover, a recent publication of international data also shows that ECMO and percutaneous temporary LVAD are associated with the worst post-transplant outcomes.…”

Section: Discussionsupporting

confidence: 83%

Elective or emergency heart transplantation: Cost comparison in a single center

Farrero

Flores‐Umanzor

Pomar

et al. 2019

Clinical Transplantation

View full text Add to dashboard Cite

Background and aims Heart transplantation (HT) is the treatment of choice for selected cases of advanced heart failure. There is an increasing rate of emergency HT in our country. The aim of this study was to determine the cost of HT in our hospital according to emergent vs. elective transplantation status. Methods The costs of all consecutive HTs performed in our center between January 2010 and May 2015 were analyzed. The cost of elective and emergent HT was compared. Results HT mean cost at our institution was €62 203 ± 47 976. Elective HT mean cost was €47 540 ± 25 140, whereas emergent HT cost was €102 733 ± 68 050 (emergency status 1, as regional priority, was €66 077 ± 28 067 and emergency status 0, as the highest national priority, was €136 056 ± 77 080; P < 0.001). Increased emergent HT cost was mainly related to a longer admission (32 ± 24 days vs. 69 ± 53 days; P = 0.006; accounting for a cost of €14 517 ± 12 475 vs. €37 846 ± 31 702; P < 0.001) and increased drug‐related expenses (€6622 ± 7465 vs. €15,171 ± 15,758; P < 0.02). Elective HT survival rate was 96%, compared to 68% for emergent HT; P = 0.002. Conclusions Elective HT showed a high survival rate with a relatively low and less variable cost, leading to a favorable economic balance in today's public health reimbursement system. In contrast, emergent HT showed a higher cost and a lower survival rate. New treatment strategies should be identified for heart failure patients at risk of requiring emergency HT.

show abstract

Section: Discussionsupporting

confidence: 83%

Elective or emergency heart transplantation: Cost comparison in a single center

Farrero

Flores‐Umanzor

Pomar

et al. 2019

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…While some of these complications such as hemolysis can be attenuated by optimizing the patient's volume status and device parameters, others may be more challenging to modify and negatively impact quality of life, survival, and ability to bridge to OHT . Although reflective of nationwide practice, the current reported experience with utilizing the Impella 5.0 device as a bridge to OHT is modest in numbers with many reports limited to case reports or small cohorts, even in studies that compile multicenter data …”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have evaluated the impact of Impella devices on survival following refractory cardiogenic shock, although prior studies analyzing the outcomes of Impella 5.0 as a direct bridge to OHT are scarce. The largest study to date is a retrospective analysis of the International Society of Heart and Lung Transplantation Registry that evaluated the outcomes of 75 patients bridged to OHT with Impella devices, which included Impella 2.5, Impella CP, and Impella 5.0 . The authors found that patients supported on Impella devices had significantly worse survival when compared to CF‐LVADs (89% vs 96% at 30 days, P = .02 and 90% vs 80% at 1 year, P < .01) but similar survival to other forms of TMCS and ECMO.…”

Section: Discussionmentioning

confidence: 99%

“…Patients supported with an Impella 5.0 receive a high priority status 2 listing under the new allocation system. Prior studies have included small case series reporting the feasibility of a direct bridge from Impella 5.0 to orthotopic heart transplantation (OHT), albeit at the risk of high complication rates and potential survival disadvantage when compared to patients supported with other types of TMCS . Considering the change in donor heart allocation, there may be changes in the proportion of patients supported with an Impella 5.0 as a bridge to OHT.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Direct bridging to cardiac transplantation with the surgically implanted Impella 5.0 device

Seese

Hickey

Keebler

et al. 2020

Clinical Transplantation

View full text Add to dashboard Cite

This study evaluated outcomes of direct bridging to orthotopic heart transplantation (OHT) with the Impella 5.0 device. Adult recipients in the United Network for Organ Sharing registry bridged to OHT with the Impella 5.0 device between 2010 to 2018 were included. Outcomes included waitlist and post‐transplant survival. A total of 236 patients were wait‐listed with Impella 5.0 support, and 24% (n = 57) underwent bridge to OHT. Early and late post‐transplant survival was excellent at 96.5% at 30 day, 93.8% at 90‐day, and 90.3% at 1‐year follow‐up. Post‐transplant complications were infrequent, but the most common were renal failure requiring dialysis (8.8%, n = 5), cerebrovascular accidents (1.8%, n = 1), and pacemaker implant (1.8%, n = 1). The rate of waitlist removal for death or clinical deterioration was 20.0% (n = 47); however, the majority of patients were bridged to OHT (24%, n = 57) or durable continuous‐flow left ventricular assist device (37.0%, n = 87). The median time supported on the device, while waitlisted was 13 days (Interquartile range [IQR] 7, 20 days). The Impella 5.0 device can be used as a direct bridge to OHT with excellent survival and minimal post‐transplant morbidity. Overall, these data support the utilization of Impella 5.0 as a bridge to OHT in select patients with refractory cardiogenic shock.

show abstract

“…Some degree of right ventricular failure (RVF) occurs in 20% to 40% of implantable CF‐LVAD recipients, and right‐sided ventricular support is required in 5% 9 . Patients requiring simultaneous T‐RVAD following CF‐LVAD are a heterogenous group including those with acute cardiogenic shock in the immediate postimplant period and patients with acute‐on‐chronic RVF weeks or months after CF‐LVAD implant.…”

Section: Discussionmentioning

confidence: 99%

Temporary left ventricular assist devices as a bridge to heart transplantation

et al. 2020

View full text Add to dashboard Cite

Background To create equitable access to donor organs for the highest mortality patients, the cardiac transplant allocation system now prioritizes patients with surgically implanted temporary left ventricular assist devices (T‐LVADs). The outcomes following a direct bridge from a T‐LVAD to orthotopic heart transplant (OHT) are not well delineated. Aim This study investigates the T‐LVAD waitlist outcomes and compares the posttransplant outcomes in patients bridged to OHT with surgically implanted T‐LVADs to patients bridged with durable continuous‐flow left ventricular assist devices (CF‐LVADs). Methods Adults recorded in the United Network for Organ Sharing registry bridged to OHT with a durable CF‐LVAD and T‐LVADs, with or without temporary right ventricular assist devices (T‐RVADs), between 2010 and 2018 were included. Propensity matching and multivariable Cox regression were utilized to compare outcomes. Results Of 504 patients waitlisted with T‐LVADs, the majority were transplanted (50%), bridged to CF‐LVAD (17%), or recovered (9%). A total of 9047 recipients were bridged to OHT during the study period with 8875 CF‐LVADs and 172 T‐LVADs. Early survival in propensity‐matched T‐LVAD ± T‐RVAD patients was similar to CF‐LVAD ± T‐RVAD patients but reduced at a 1‐year follow‐up. This difference in survival at 1‐year follow‐up was attributable to significantly reduced survival in patients with combined T‐LVAD + T‐RVAD support when compared with CF‐LVAD, isolated T‐LVAD and combined CF‐LVAD + T‐RVAD support (80% vs 90% vs 90% vs 91%; P = .005). Conclusions This study demonstrates that most patients waitlisted with a T‐LVAD are successfully bridged to durable therapy or recover, and those bridged to OHT have acceptable posttransplant outcomes, particularly when T‐RVADs are not required.

show abstract

Post-transplant outcome in patients bridged to transplant with temporary mechanical circulatory support devices

Cited by 92 publications

References 47 publications

Elective or emergency heart transplantation: Cost comparison in a single center

Elective or emergency heart transplantation: Cost comparison in a single center

Direct bridging to cardiac transplantation with the surgically implanted Impella 5.0 device

Temporary left ventricular assist devices as a bridge to heart transplantation

Contact Info

Product

Resources

About