30 Years of Heart Transplant: Outcomes After Mechanical Circulatory Support From a Single Center

Finnan, Michael J; Bakir, Nadia H.; Itoh, Akinobu; Kotkar, Kunal; Pasque, Michael K.; Damiano, Ralph J.; Moon, Marc R.; Ewald, Gregory A.; Schilling, Joel D.; Masood, Muhammad

doi:10.1016/j.athoracsur.2021.01.064

Cited by 8 publications

(5 citation statements)

References 14 publications

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“…If the patient is not eligible for either option because of ongoing severe infection, uncontrolled bleeding, or larger dekubitus ulcer, temporary MCS treatment can be maintained until the patient is recovering from temporary contraindication (bridge to candidacy = BTC). However, if the patient is eligible for HTx, temporary MCS treatment can be maintained as a bridge to urgent HTx (bridge to transplant = BTT) [12,13]. Additionally, if the patient is eligible for long-term mechanical circulatory support (LT-MCS) such as destination therapy (DT), temporary MCS may be maintained until clinical improvement provides acceptable peri-operative risk for LT-MCS implantation [14].…”

Section: Temporary Mechanical Circulatory Supportmentioning

confidence: 99%

“…In this context, the two centers have agreed on an algorithm paving the treatment of the advanced HF patient >65 years of age. Acknowledging that the indications for surgical care of the younger advanced HF patient are set out clearly by the International Society of Heart and Lung Transplantation and the European Association of Cardiothoracic Surgery [13,108], these were not taken into consideration by this algorithm (Figure 2).…”

Section: Taking Care Of the Aged Advanced Heart Failure Patient In The French-speaking Part Of Switzerlandmentioning

confidence: 99%

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Cardiac Surgery in Advanced Heart Failure

Hullin

Meyer

Yerly

et al. 2022

JCM

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Mechanical circulatory support and heart transplantation are established surgical options for treatment of advanced heart failure. Since the prevalence of advanced heart failure is progressively increasing, there is a clear need to treat more patients with mechanical circulatory support and to increase the number of heart transplantations. This narrative review summarizes recent progress in surgical treatment options of advanced heart failure and proposes an algorithm for treatment of the advanced heart failure patient at >65 years of age.

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Section: Temporary Mechanical Circulatory Supportmentioning

confidence: 99%

Section: Taking Care Of the Aged Advanced Heart Failure Patient In The French-speaking Part Of Switzerlandmentioning

confidence: 99%

Cardiac Surgery in Advanced Heart Failure

Hullin

Meyer

Yerly

et al. 2022

JCM

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“…Other cardiac surgeries, apart from those stated earlier, were recognized as conventional cardiac surgeries. The rationale behind this exclusion is that VADs serve as alternative tools to stabilize patients and potentially improve the outcome of HT, which introduces selection bias [ 8 , 9 ]. Furthermore, re-transplantation for allograft dysfunction is known to have a poor prognosis because of immune sensitization [ 15 , 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…Before transplantation, high-risk conventional cardiac surgery cannot be completely avoided, as it still serves as an alternative strategy in cases where the organ is unavailable [7]. However, with advancements in ventricular assist devices (VADs), up to 45% of HTs are performed in recipients who have received mechanical circulatory support before transplantation, and the outcomes have been satisfactory [8][9][10]. Although VAD implantation also requires an open chest and increases the complexity of subsequent HT, its benefits can mitigate the negative impact of re-sternotomy [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Impact of Previous Conventional Cardiac Surgery on the Clinical Outcomes After Heart Transplantation

Chen,

Chou,

Chou

et al. 2023

Transpl Int

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The impact of the type, purpose, and timing of prior surgery on heart transplantation (HT) remains unclear. This study investigated the influence of conventional cardiac surgery (PCCS) on HT outcomes. This study analyzed HTs performed between 1999 and 2019 at a single institution. Patients were categorized into two groups: those with and without PCCS. Short-term outcomes, including post-transplant complications and mortality rates, were evaluated. Cox proportional and Kaplan–Meier survival analyses were used to identify risk factors for mortality and assess long-term survival, respectively. Of 368 patients, 29% had PCCS. Patients with PCCS had a higher incidence of post-transplant complications. The in-hospital and 1 year mortality rates were higher in the PCCS group. PCCS and cardiopulmonary bypass time were significant risk factors for 1 year mortality (hazard ratios = 2.485 and 1.005, respectively). The long-term survival rates were lower in the PCCS group, particularly in the first year. In sub-analysis, patients with ischemic cardiomyopathy and PCCS had the poorest outcomes. The era of surgery and timing of PCCS in relation to HT did not significantly impact outcomes. In conclusion, PCCS worsen the HT outcomes, especially in patients with ischemic etiology. However, the timing of PCCS and era of HT did not significantly affect this concern.

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“…Clinicians have drastically changed their practice to utilize temporary MCS as BTT strategies. Finnan et al have just reported on their single-center 30-year results of heart transplantation after mechanical circulatory support [25 ▪ ]. Within their report, they identify utilization of temporary MCS in between 1% and of 12% their patients in the years prior to the allocation system change, however, immediately after the change, this proportion grew to 58% (primarily with the use of intra-aortic balloon pump use).…”

Section: Impact Of the Changes To The Unos Donor Heart Allocation Systemmentioning

confidence: 99%

Durable mechanical circulatory support as bridge to heart transplantation

Badiwala

Dvirnik²,

Rao³

2022

Current Opinion in Organ Transplantation

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Purpose of reviewDurable mechanical circulatory support (MCS) technology has changed over time as devices have evolved from pulsatile to continuous flow support. In this review, we discuss recent data and substantial changes to current practice as it pertains to the subject of current era durable left ventricular assist devices (LVADs) as a bridge to heart transplantation.Recent findingsThe results of heart transplantation in patients bridged with durable LVAD support are satisfactory even after prolonged duration of support. Reports of recent experience with LVAD related infection suggest that this complication has limited impact on post-transplant outcomes. Important sex-related disparities continue to exist following durable LVAD implantation. Recent changes in the United Network for Organ Sharing donor heart allocation policy have resulted in a drastic decline in the use of durable LVAD support for Bridge to Transplant in the United States.SummaryDurable MCS in the form of LVAD as a BTT strategy continues to evolve over time. Optimization of its role in the treatment of end-stage heart failure, particularly in females will need to be the focus of future research.

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30 Years of Heart Transplant: Outcomes After Mechanical Circulatory Support From a Single Center

Cited by 8 publications

References 14 publications

Cardiac Surgery in Advanced Heart Failure

Cardiac Surgery in Advanced Heart Failure

Impact of Previous Conventional Cardiac Surgery on the Clinical Outcomes After Heart Transplantation

Durable mechanical circulatory support as bridge to heart transplantation

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