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| Format: | Artículo Open Access |
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Wiley
2024
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| Online Access: | https://onlinelibrary.wiley.com/doi/10.1111/ctr.15334 |
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| author | Lucrecia M. Burgos Fiorella S. Chicote Mariano Vrancic Leonardo Seoane Franco N. Ballari Rocio C. Baro Vila María A. De Bortoli Juan F. Furmento Juan P. Costabel Fernando Piccinini Daniel Navia Juan Espinoza Mirta Diez |
| author_facet | Lucrecia M. Burgos Fiorella S. Chicote Mariano Vrancic Leonardo Seoane Franco N. Ballari Rocio C. Baro Vila María A. De Bortoli Juan F. Furmento Juan P. Costabel Fernando Piccinini Daniel Navia Juan Espinoza Mirta Diez Lucrecia M. Burgos Fiorella S. Chicote Mariano Vrancic Leonardo Seoane Franco N. Ballari Rocio C. Baro Vila María A. De Bortoli Juan F. Furmento Juan P. Costabel Fernando Piccinini Daniel Navia Juan Espinoza Mirta Diez |
| collection | Wiley Open Access |
| contents | Veno‐arterial ECMO ventricular assistance as a direct bridge to heart transplant: A single center experience in a low‐middle income country Lucrecia M. Burgos Fiorella S. Chicote Mariano Vrancic Leonardo Seoane Franco N. Ballari Rocio C. Baro Vila María A. De Bortoli Juan F. Furmento Juan P. Costabel Fernando Piccinini Daniel Navia Juan Espinoza Mirta Diez Clinical Transplantation AbstractIntroductionThe use of veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) as a direct bridge to heart transplantation (BTT) is not common in adults worldwide. BTT with ECMO is associated with increased early/mid‐term mortality compared with other interventions. In low‐ and middle‐income countries (LMIC), where no other type of short‐term mechanical circulatory support is available, its use is widespread and increasingly used as rescue therapy in patients with cardiogenic shock (CS) as a direct bridge to heart transplantation (HT).ObjectiveTo assess the outcomes of adult patients using VA‐ECMO as a direct BTT in an LMIC and compare them with international registries.MethodsWe conducted a single‐center study analyzing consecutive adult patients requiring VA‐ECMO as BTT due to refractory CS or cardiac arrest (CA) in a cardiovascular center in Argentina between January 2014 and December 2022. Survival and adverse clinical events after VA‐ECMO implantation were evaluated.ResultsOf 86 VA‐ECMO, 22 (25.5%) were implanted as initial BTT strategy, and 52.1% of them underwent HT. Mean age was 46 years (SD 12); 59% were male. ECMO was indicated in 81% for CS, and the most common underlying condition was coronary artery disease (31.8%). Overall, in‐hospital mortality for VA‐ECMO as BTT was 50%. Survival to discharge was 83% in those who underwent HT and 10% in those who did not, p < .001. In those who did not undergo HT, the main cause of death was hemorrhagic complications (44%), followed by thrombotic complications (33%). The median duration of VA‐ECMO was 6 days (IQR 3‐16). There were no differences in the number of days on ECMO between those who received a transplant and those who did not. In the Spanish registry, in‐hospital survival after HT was 66.7%; the United Network of Organ Sharing registry estimated post‐transplant survival at 73.1% ± 4.4%, and in the French national registry 1‐year posttransplant survival was 70% in the VA‐ECMO group.ConclusionsIn adult patients with cardiogenic shock, VA‐ECMO as a direct BTT allowed successful HT in half of the patients. HT provided a survival benefit in listed patients on VA‐ECMO. We present a single center experience with results comparable to those of international registries. 10.1111/ctr.15334 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/ctr.15334 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_15334 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2024 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Veno‐arterial ECMO ventricular assistance as a direct bridge to heart transplant: A single center experience in a low‐middle income country Lucrecia M. Burgos Fiorella S. Chicote Mariano Vrancic Leonardo Seoane Franco N. Ballari Rocio C. Baro Vila María A. De Bortoli Juan F. Furmento Juan P. Costabel Fernando Piccinini Daniel Navia Juan Espinoza Mirta Diez Clinical Transplantation Veno‐arterial ECMO ventricular assistance as a direct bridge to heart transplant: A single center experience in a low‐middle income country Lucrecia M. Burgos Fiorella S. Chicote Mariano Vrancic Leonardo Seoane Franco N. Ballari Rocio C. Baro Vila María A. De Bortoli Juan F. Furmento Juan P. Costabel Fernando Piccinini Daniel Navia Juan Espinoza Mirta Diez Clinical Transplantation AbstractIntroductionThe use of veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) as a direct bridge to heart transplantation (BTT) is not common in adults worldwide. BTT with ECMO is associated with increased early/mid‐term mortality compared with other interventions. In low‐ and middle‐income countries (LMIC), where no other type of short‐term mechanical circulatory support is available, its use is widespread and increasingly used as rescue therapy in patients with cardiogenic shock (CS) as a direct bridge to heart transplantation (HT).ObjectiveTo assess the outcomes of adult patients using VA‐ECMO as a direct BTT in an LMIC and compare them with international registries.MethodsWe conducted a single‐center study analyzing consecutive adult patients requiring VA‐ECMO as BTT due to refractory CS or cardiac arrest (CA) in a cardiovascular center in Argentina between January 2014 and December 2022. Survival and adverse clinical events after VA‐ECMO implantation were evaluated.ResultsOf 86 VA‐ECMO, 22 (25.5%) were implanted as initial BTT strategy, and 52.1% of them underwent HT. Mean age was 46 years (SD 12); 59% were male. ECMO was indicated in 81% for CS, and the most common underlying condition was coronary artery disease (31.8%). Overall, in‐hospital mortality for VA‐ECMO as BTT was 50%. Survival to discharge was 83% in those who underwent HT and 10% in those who did not, p < .001. In those who did not undergo HT, the main cause of death was hemorrhagic complications (44%), followed by thrombotic complications (33%). The median duration of VA‐ECMO was 6 days (IQR 3‐16). There were no differences in the number of days on ECMO between those who received a transplant and those who did not. In the Spanish registry, in‐hospital survival after HT was 66.7%; the United Network of Organ Sharing registry estimated post‐transplant survival at 73.1% ± 4.4%, and in the French national registry 1‐year posttransplant survival was 70% in the VA‐ECMO group.ConclusionsIn adult patients with cardiogenic shock, VA‐ECMO as a direct BTT allowed successful HT in half of the patients. HT provided a survival benefit in listed patients on VA‐ECMO. We present a single center experience with results comparable to those of international registries. 10.1111/ctr.15334 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | Veno‐arterial ECMO ventricular assistance as a direct bridge to heart transplant: A single center experience in a low‐middle income country |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.15334 |