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

Venoarterial extracorporeal membrane oxygenation (ECMO) use as a bridge to transplant is extremely infrequent in adults. We investigated patient outcomes of the use of ECMO as bridge to transplant. United Network of Organ Sharing provided de-identified patient-level data. Between 2003 and 2016, 25,168 adult recipients were identified. Of these, 107 (0.4%) were bridged with ECMO and 6148 (24.4%) were bridged with a continuous-flow left ventricular assist device. Patients in ECMO group were younger, more likely to have severely disabled functional status, shorter waitlist time, and were more frequently mechanically ventilated than were patients in the continuous-flow left ventricular assist device group. Kaplan-Meier analysis demonstrated estimated posttransplant survival of 73.1% versus 93.1% at 90 days (P < .001) and 67.4% versus 82.4% at 3 years (P < .001) in ECMO and continuous-flow left ventricular assist device groups, respectively. Analysis of a propensity-matched cohort still demonstrated a lower survival in ECMO group at 90 days (74.8% vs 88.8%; P = .025) and 3 years (69.3% vs 82.2%; P = .054). Among the ECMO patients, multivariable logistic and Cox regression analyses showed model for end-stage liver disease excluding international normalized ratio (MELD-XI) score to be the sole contributor to both 90-day (odds ratio, 1.94; 95% confidence interval, 1.00-3.76; P = .050) and 3-year mortality (hazard ratio, 1.47; 95% confidence interval, 1.16-1.88; P = .002). ECMO-supported patients with a high MELD-XI score (>17) were associated with poor posttransplant survival compared with those with a low MELD-XI score (<13) (90 day, 54.4% vs 85.0% [P < .001] and 3 year, 49.5% vs 73.5% [P < .001]). Bridge to transplant with ECMO was associated with increased early/mid-term mortality, especially in patients with a high MELD-XI score who demonstrated > 50% 3-year mortality. These findings may help to inform future organ allocation policies.

Fukuhara S ，Takeda K ，Kurlansky PA ，Naka Y ，Takayama H ... -  《-》

Impact of Left Ventricular Unloading on Outcome of Heart Transplant Bridging With Extracorporeal Membrane Oxygenation Support in New Allocation Policy.

Gregory V ，Okumura K ，Isath A ，Levine A ，De La Pena C ，Shimamura J ，Spielvogel D ，Kai M ，Ohira S ... -  《-》

Baseline MELD-XI score and outcome from veno-arterial extracorporeal membrane oxygenation support for acute decompensated heart failure.

Sern Lim H 《-》

Posttransplant Outcomes Among Septuagenarians Bridged to Transplantation With Continuous-Flow Left Ventricular Assist Devices.

A bridge to transplant strategy with a continuous-flow left ventricular assist device is increasingly being offered to older patients. However, the upper patient age limit has not been defined. The United Network of Organ Sharing (UNOS) database was used to identify 21,258 heart transplant recipients from 2004 to 2014. Of these, 4,850 (22.8%) were bridged with a continuous-flow left ventricular assist device. Recipients were stratified by age: group 1, aged 70 years or more (n = 115, 2.4%); and group 2, aged 18 to 69 years (n = 4,735, 97.6%). Elderly patients more likely had ischemic etiology than younger patients (69.6% versus 41.0%; p < 0.001), and received a heart from an older donor (35.8 versus 31.3 years, p < 0.001) or an expanded criteria donor (8.7% versus 2.4%; p < 0.001). Elderly patients had decreased 90-day survival (88.8% versus 93.2%; p = 0.021) and 3-year posttransplant survival (80.9% versus 85.7%; p = 0.073). However, analysis of a propensity matched cohort did not demonstrate survival difference at 90 days and 3 years. Among septuagenarians, the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score was a predictor for 90-day mortality (hazard ratio 4.48, 95% confidence interval: 1.90 to 10.55; p = 0.001) and 3-year mortality (hazard ratio 2.27, 95% confidence interval: 1.51 to 3.41; p < 0.001), whereas functional independence was protective for 3-year mortality (hazard ratio 0.11, 95% confidence interval: 0.013 to 0.86; p = 0.036). Functionally independent patients showed a remarkably superior posttransplant survival compared with functionally dependent patients (96.7% versus 42.8% at 3 years; p = 0.001). The continuous-flow left ventricular assist device supported septuagenarians did not have increased posttransplant mortality. Functional outcomes during device support may have important implications for organ allocation among the elderly.

Fukuhara S ，Takeda K ，Blair A ，Kurlansky PA ，Takayama H ，Naka Y ... -  《-》

Impact of Heart Transplantation on Survival in Patients on Venoarterial Extracorporeal Membrane Oxygenation at Listing in France.

Jasseron C ，Lebreton G ，Cantrelle C ，Legeai C ，Leprince P ，Flecher E ，Sirinelli A ，Bastien O ，Dorent R ... -  《-》