Bridge to heart transplantation in patients with cardiogenic shock: a 20-year experience with two different surgical strategies

Sponga, Sandro; Nagpal, A. Dave; Vendramin, Igor; Ferrara, Veronica; Lechiancole, Andrea; Maiani, Massimo; Nalli, Chiara; Nora, Concetta Di; Guzzi, G.; Manna, Nunzio Davide de; Bortolotti, Uberto; Livi, Ugolino

doi:10.2459/jcm.0000000000001097

Cited by 6 publications

(8 citation statements)

References 27 publications

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“…Other conditions that were reported to be risk factors for death are infection, high levels of lactate, and liver dysfunction [5,[6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Outcomes Of Btt With Ecmomentioning

confidence: 99%

“…On the other hand, patients supported with ECMO who could not be weaned and have major risk factors may warrant consideration for an alternative to HT, such as LVAD implantation. In fact, it has been argued that perhaps a strategy of transitioning ECMO supported patients to durable MCS may provide the stabilization required to guarantee better post HT outcomes and more judicious use of transplanted hearts [9,19], but limited and controversial evidence does not permit to generate recommendations.…”

Section: Listing Ecmo Patientsmentioning

confidence: 99%

See 1 more Smart Citation

ECMO as Bridge to Heart Transplantation

Lechiancole¹,

Maiani²,

Vendramin³

et al. 2023

Extracorporeal Membrane Oxygenation Support Therapy

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Extracorporeal membrane oxygenation (ECMO) is increasingly employed to support patients affected by refractory cardiogenic shock. When patients cannot be weaned from ECMO because of severe heart dysfunction, heart transplantation (HTx) or implantation of a durable mechanical circulatory support should be considered. Traditionally, the use of ECMO as a direct bridge to HTx was burdened by high mortality. However, during these last years, the widespread employment of ECMO increased centers’ experience in the management of this device, and new allocation policies provided the highest priority level for ECMO HTx candidates. Therefore, these factors could have mitigated the negative outcomes previously reported. The aim of this chapter is to describe the role of ECMO as a direct bridge to HTx, analyzing results of this strategy, and how to determine candidacy and risk stratification among the severely ill population of patients supported by this mechanical circulatory support.

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“…Other conditions that were reported to be risk factors for death are infection, high levels of lactate, and liver dysfunction [5,[6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Outcomes Of Btt With Ecmomentioning

confidence: 99%

Section: Listing Ecmo Patientsmentioning

confidence: 99%

ECMO as Bridge to Heart Transplantation

Lechiancole¹,

Maiani²,

Vendramin³

et al. 2023

Extracorporeal Membrane Oxygenation Support Therapy

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“…The Swedish evaluation of left ventricular assist device (SweVAD) study will provide further data regarding LVAD implantation as the destination therapy in patients with advanced HF ineligible for heart transplantation 72 . Biventricular assist device may have a role in selected patients, 73 but further research is needed.…”

Section: Advanced Heart Failurementioning

confidence: 99%

Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming

Cimino

Pancaldi

Tomasoni

et al. 2022

Journal of Cardiovascular Medicine

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Prevalence of heart failure is increasing worldwide mainly due to the ageing of the population and the improvement in diagnosis and treatment. In recent years, huge progress has been made in the management of heart failure patients. A new definition of chronic heart failure based on left ventricular ejection fraction and its possible trajectories has been reported. New drug classes have been introduced for the treatment of chronic heart failure. In particular, the prognostic benefit of sodium glucose co-transporter 2 inhibitors was demonstrated across all the heart failure phenotypes. Therapies for patients with advanced heart failure (long-term mechanical circulatory supports and heart transplantation) are now indicated also in the case of mild-to-moderate symptoms but with high risk of progression. In patients with acute heart failure, monitoring of urinary sodium and the use of acetazolamide may lead to better decongestion. Importantly, pre- and postdischarge assessment should lead to optimal treatment. Devices and telemonitoring can also be of help. Cardiovascular and noncardiovascular comorbidities are major determinants of the clinical course and need proper management. This review will summarize these important advances.

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“…ESRD alone increased the risk of readmission within 30 days [7]. A study evaluated the use of extracorporeal life support (ECLS) or biventricular device (BiVAD) in patients in cardiogenic shock bridged to heart transplantation and found that patients with extracorporeal support had higher rates of renal failure (P = 0.02) compared to the BiVAD patients [32].…”

Section: Outcomes With Lvad In End-stage Renal Diseasementioning

confidence: 99%

Outcomes With Left Ventricular Assist Device in End-Stage Renal Disease: A Systematic Review

Lakhdar¹,

Nassar²,

Buttar³

et al. 2022

Cureus

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Renal dysfunction is a common comorbidity in patients with advanced heart failure who may benefit from mechanical circulatory support (MCS). Unfortunately, renal function may result after left ventricular assist device (LVAD) implantation. The purpose of this study is to examine the outcomes of advanced heart failure patients with end-stage renal disease (ESRD) requiring mechanical circulatory support as a bridge to transplant (BTT) or destination therapy (DT). We searched Medline, Embase, and Cochrane in September 2021. The following keywords were used: left ventricular assist device or LVAD and end-stage renal disease or ESRD. Our study included case reports, case series, descriptive studies, and randomized control trials. Review articles, guidelines, systematic reviews, and meta-analyses were excluded. We also excluded pediatric cases. We identified 278 articles; 92 were duplicated, 186 articles entered the screening phase, and 133 articles were excluded by title and abstract. After the full-text screening, 40 articles were excluded. This systematic review included 13 articles. Among the contraindications to LVAD implantation, a general contraindication is for patients found to have stage 4 chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR): <30 mL/minute/1.73 m 2 ), while those on dialysis are an absolute contraindication LVAD implantation. Despite the limited data and publications on LVADs in patients with ESRD, LVAD implantation as a bridge to transplantation or destination therapy may be considered in selected patients without increasing morbidity and mortality. Therefore, shared decision-making around the treatment of advanced heart failure with these patients and the care team is essential.

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Bridge to heart transplantation in patients with cardiogenic shock: a 20-year experience with two different surgical strategies

Cited by 6 publications

References 27 publications

ECMO as Bridge to Heart Transplantation

ECMO as Bridge to Heart Transplantation

Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming

Outcomes With Left Ventricular Assist Device in End-Stage Renal Disease: A Systematic Review

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