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Post-transplant survival with pre-transplant durable continuous-flow mechanical circulatory support in a Swiss cohort of heart transplant recipients.
Hullin, Roger; Abdurashidova, Tamila; Pitta-Gros, Barbara; Schukraft, Sara; Rancati, Valentina; Lu, Henri; Zurbuchen, Anouck; Marcucci, Carlo; Ltaief, Zied; Lefol, Karl; Huber, Christoph; Pascual, Manuel; Tozzi, Piergiorgio; Meyer, Philippe; Kirsch, Matthias.
Afiliación
  • Hullin R; Cardiology, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
  • Abdurashidova T; Cardiology, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
  • Pitta-Gros B; Cardiology, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
  • Schukraft S; Cardiology, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
  • Rancati V; Anesthesiology, Surgical Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
  • Lu H; Cardiology, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
  • Zurbuchen A; Cardiology, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
  • Marcucci C; Anesthesiology, Surgical Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
  • Ltaief Z; Intensive Care Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
  • Lefol K; Solid Organ Transplantation Center, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
  • Huber C; Cardiac Surgery, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
  • Pascual M; Solid Organ Transplantation Center, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
  • Tozzi P; Cardiology, Department of Medical Specialties and Cardiovascular Surgery, Department of Surgery, Geneva University Hospital, University of Geneva, Geneva, Switzerland.
  • Meyer P; Cardiac Surgery, Cardiovascular Department, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
  • Kirsch M; Cardiology, Department of Medical Specialties and Cardiovascular Surgery, Department of Surgery, Geneva University Hospital, University of Geneva, Geneva, Switzerland.
Swiss Med Wkly ; 153: 3500, 2023 Dec 04.
Article en En | MEDLINE | ID: mdl-38579299
ABSTRACT

BACKGROUND:

Worldwide, almost half of all heart transplantation candidates arrive today at their transplant operation with durable continuous-flow mechanical circulatory support (CF-MCS). This evolution is due to a progressive increase of waiting list time and hence an increased risk of haemodynamic worsening. Longer duration of CF-MCS is associated with a higher risk of device-related complications with potential adverse impact on post-transplant outcome as suggested by recent results from the United Network of Organ Sharing of the United States.

METHODS:

A 2-centre Swiss heart transplantation programme conducted a retrospective observational study of consecutive patients of theirs who underwent a transplant in the period 2008-2020. The primary aim was to determine whether post-transplant all-cause mortality is different between heart transplant recipients without or with pre-transplant CF-MCS. The secondary outcome was the acute cellular rejection score within the first year post-transplant.

RESULTS:

The study participants had a median age of 54 years; 38/158 (24%) were females. 53/158 study participants (34%) had pre-transplant CF-MCS with a median treatment duration of 280 days. In heart transplant recipients with pre-transplant CF-MCS, the prevalence of ischaemic cardiomyopathy was higher (51 vs 32%; p = 0.013), the left ventricular ejection fraction was lower (20 vs 25; p = 0.047) and pulmonary vascular resistance was higher (2.3 vs 2.1 Wood Units; p = 0.047). Over the study period, the proportion of heart transplant recipients with pre-transplant CF-MCS and the duration of pre-transplant CF-MCS treatment increased (2008-2014 vs 2015-2020 22% vs 45%, p = 0.009; increase of treatment days per year 34.4 ± 11.2 days, p = 0.003; respectively). The primary and secondary outcomes were not different between heart transplant recipients with pre-transplant CF-MCS or direct heart transplantation (log-rank p = 0.515; 0.16 vs 0.14, respectively; p = 0.81).

CONCLUSION:

This data indicates that the strategy of pre-transplant CF-MCS with subsequent orthotopic heart transplantation provides post-transplant outcomes not different to direct heart transplantation despite the fact that the duration of pre-transplant assist device treatment has progressively increased.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Corazón Auxiliar / Trasplante de Corazón / Insuficiencia Cardíaca Límite: Female / Humans / Male / Middle aged País/Región como asunto: America do norte / Europa Idioma: En Revista: Swiss Med Wkly Asunto de la revista: MEDICINA Año: 2023 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Suiza
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Corazón Auxiliar / Trasplante de Corazón / Insuficiencia Cardíaca Límite: Female / Humans / Male / Middle aged País/Región como asunto: America do norte / Europa Idioma: En Revista: Swiss Med Wkly Asunto de la revista: MEDICINA Año: 2023 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Suiza