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Impact of Temporary Percutaneous Mechanical Circulatory Support Before Transplantation in the 2018 Heart Allocation System.
Clerkin, Kevin J; Salako, Oluwafeyijimi; Fried, Justin A; Griffin, Jan M; Raikhelkar, Jayant; Jain, Rashmi; Restaino, Susan; Colombo, Paolo C; Takeda, Koji; Farr, Maryjane A; Sayer, Gabriel; Uriel, Nir; Topkara, Veli K.
Afiliação
  • Clerkin KJ; Milstein Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
  • Salako O; Milstein Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
  • Fried JA; Milstein Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
  • Griffin JM; Milstein Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
  • Raikhelkar J; Milstein Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
  • Jain R; Milstein Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
  • Restaino S; Milstein Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
  • Colombo PC; Milstein Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
  • Takeda K; Division of Cardiac Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
  • Farr MA; Milstein Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
  • Sayer G; Milstein Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
  • Uriel N; Milstein Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
  • Topkara VK; Milstein Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA. Electronic address: vt2113@cumc.columbia.edu.
JACC Heart Fail ; 10(1): 12-23, 2022 01.
Article em En | MEDLINE | ID: mdl-34969492
OBJECTIVES: This analysis sought to investigate the waitlist and post-transplant outcomes of individuals bridged to transplantation by using temporary percutaneous endovascular mechanical circulatory support (tMCS) through a status 2 designation (cardiogenic shock and exception). BACKGROUND: The 2018 donor heart allocation policy change granted a status 2 designation to patients supported with tMCS. METHODS: Adult patients in the United Network for Organ Sharing registry after October 18, 2018 who received a status 2 designation for tMCS were included and grouped by their status 2 criteria: cardiogenic shock with hemodynamic criteria (CS-HD), cardiogenic shock without hemodynamic criteria before tMCS (CS-woHD), and exception. Baseline characteristics, waitlist events (death and delisting), and post-transplant outcomes were compared. RESULTS: A total of 2,279 patients met inclusion criteria: 68.6% (n = 1,564) with CS-HD, 3.2% (n = 73) with CS-woHD, and 28.2% (n = 642) with exceptions. A total of 64.2% of patients underwent heart transplantation within 14 days of status 2 listing or upgrade, and 1.9% died or were delisted for worsening clinical condition. Among the 35.8% who did not undergo transplantation following 14 days, only 2.8% went on to receive a left ventricular assist device (LVAD). The 30-day transplantation likelihood was similar among groups: 80.1% for the CS-HD group vs 79.7% for the exception group vs 73.3% for the CS-woHD group; P = 0.31. However, patients who met criteria for CS-woHD had 2.3-fold greater risk of death or delisting (95% CI: 1.10-4.75; P = 0.03) compared with CS-HD patients after multivariable adjustment. Pre-tMCS hemodynamics were not associated with adverse waitlist events. CONCLUSIONS: The use of tMCS is an efficient, safe, and effective strategy as a bridge to transplantation; however, patients with CS-woHD may represent a high-risk cohort. Transition to a durable LVAD was a rare event in this group.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Oxigenação por Membrana Extracorpórea / Coração Auxiliar / Transplante de Coração / Insuficiência Cardíaca Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Adult / Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Oxigenação por Membrana Extracorpórea / Coração Auxiliar / Transplante de Coração / Insuficiência Cardíaca Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Adult / Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article