Prolonged continuous-flow left ventricular assist device support and posttransplantation outcomes: A new challenge

Fukuhara, Shinichi; Takeda, Koji; Polanco, Antonio; Takayama, Hiroo; Naka, Yoshifumi

doi:10.1016/j.jtcvs.2015.10.024

Cited by 36 publications

(47 citation statements)

References 19 publications

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“…Although these data are relatively preliminary, MIS‐VAD patients potentially experience increased survival compared to conventional full sternotomy patients. As mentioned previously, the literature is currently unclear about the long‐term effects of preoperative VAD support in HTx patients . In general, the VAD support time before HTx has been shorter in American patients than in European cohorts in publications to date, and the support duration might have been a relevant factor for these effects .…”

Section: Discussionmentioning

confidence: 99%

“…As a result, an increasing number of patients with VADs are undergoing transplantation . Current data are still unclear whether former VAD support, especially with a prolonged support time, may impair the outcome after HTx . Whereas data from the International Thoracic Organ Transplant Registry of the International Society of Heart and Lung Transplant showed no significant differences between patients undergoing primary HTx and patients with implanted VADs undergoing HTx, Rizwan et al reported a worse outcome for a large cohort of young adults who received a bridge treatment with a VAD.…”

Section: Introductionmentioning

confidence: 99%

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Heart transplantation in patients with ventricular assist devices: Impacts of the implantation technique and support duration

et al. 2019

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Background: Orthotopic heart transplantation (HTx) is the gold standard treatment for patients with terminal heart failure. As donor organs are limited, patients are often on ventricular assist device (VAD) support before receiving HTx. We aimed to compare the outcome after HTx in patients with and without preoperative VADs as well as in patients who underwent different VAD implantation techniques.Methods: A total of 126 patients underwent HTx at our department between 2010 and 2019 and were retrospectively analyzed. While 47 patients underwent primary transplantation (No VAD), 79 were on VAD support. The preoperative and intraoperative parameters were comparable between the two groups.Results: VAD support significantly increased the HTx operation time (<0.0001), cardiopulmonary bypass time (P < .01), and warm ischemia time (P = .04). The ventilation time (P = .02), intensive care unit (ICU) stay (P = .01), and hospital stay (P = .02) were also significantly longer in VAD patients than in No VAD patients.Minimally invasive VAD implantation significantly reduced the requirement for perioperative blood transfusion (P = .01) and rethoracotomy (P = .01). Nonetheless, survival analyses did not show significant differences between the groups, but there was a trend of better results for the primary transplantation patients (30-day survival: No VAD = 91.1%, VAD = 86.1%; n.s.). Conclusions:We observed significantly worse perioperative parameters in patients who underwent transplantation after the implantation of a VAD compared to those who underwent primary transplantation. Minimally invasive VAD implantation without full sternotomy decreased complications during the subsequent HTx. In patients who are dependent on temporary VAD support as a bridge to transplantation, we believe that minimally invasive implantation should be performed if possible. K E Y W O R D Sheart transplantation, ventricular assist device

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Heart transplantation in patients with ventricular assist devices: Impacts of the implantation technique and support duration

et al. 2019

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“…Specifically, the bridge-to-transplant (BTT) strategy with continuous-flow ventricular assist devices (CF-LVADs) has played a major role in providing temporary support for adult patients with end-stage heart failure. 1 Additionally, venoarterial extracorporeal membrane oxygenation (ECMO) use as a rescue therapy in the setting of acute cardiac failure has also been increasing in recent years, 2,3 whereas use of ECMO as a direct bridge to transplantation in adult populations is extremely infrequent worldwide, particularly in the United States. 4 Each adult heart transplant candidate at time of registration is assigned a status that reflects his or her medical urgency for transplant.…”

Section: See Editorial Commentary Page 1619mentioning

confidence: 99%

Extracorporeal membrane oxygenation as a direct bridge to heart transplantation in adults

Fukuhara

Takeda

Kurlansky

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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125

109

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“…The scarcity of donors has led to the generation of a whole field of mechanical circulatory support devices which has brought in a new era in the treatment of advanced heart failure. The use of continuous flow LVADs as a bridge to transplantation (BTT) has become more popular and the mainstay of patients waiting on the transplant list [32]. More recently, VA-ECMO is being increasingly used as a rescue therapy [33,34] However, this trend has now led to the use of ECMO as a direct bridge to transplantation in adults.…”

Section: Ecmo As a Bridge To Transplantationmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation as a Bridge to Cardiac Transplantation

Nair¹,

Góngora²

2019

Advances in Extracorporeal Membrane Oxygenation - Volume 3

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Extracorporeal membrane oxygenation (ECMO) is a technique used for temporary support of patients with end-stage heart or lung failure. This review will focus on the venoarterial ECMO system and its use as a bridge to other long-term durable devices and/or cardiac transplantation. It can be used as a bridge to decision because it helps to gain time to stabilize the patient for further evaluation for long-term treatment such as durable mechanical circulatory pumps or transplantation. ECMO is evolving as a treatment for patients waiting on the transplant list. Increasing utilization of ECMO in adults has revealed some of the common complications such as bleeding and coagulopathy which impact survival in this patient population. The use of VA ECMO as a technique for rescuing patients from cardiogenic shock is very attractive. However, considering the extensive set of complications and the mortality it brings with it makes it a less attractive option as a direct bridge to cardiac transplant. The literature currently on this subject is very scanty and limited to a few studies of small numbers of patients. Further definitive research is needed for consensus on the role of VA ECMO as a bridge to cardiac transplant.

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Prolonged continuous-flow left ventricular assist device support and posttransplantation outcomes: A new challenge

Abstract: A bridge-to-transplant (BTT) strategy with a CF-LVAD has become standard care for patients with advanced heart failure. Duration of CF-LVAD support is associated with increased midterm mortality, warranting early transplantation in the modern BTT era.

Cited by 36 publications

References 19 publications

Heart transplantation in patients with ventricular assist devices: Impacts of the implantation technique and support duration

Heart transplantation in patients with ventricular assist devices: Impacts of the implantation technique and support duration

Extracorporeal membrane oxygenation as a direct bridge to heart transplantation in adults

Extracorporeal Membrane Oxygenation as a Bridge to Cardiac Transplantation

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