Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Impact of the Pre-transplant Circulatory Supportive Strategy on Post-transplant Outcome: Double Bridge May Work

Version 1 : Received: 4 September 2021 / Approved: 6 September 2021 / Online: 6 September 2021 (14:39:13 CEST)

A peer-reviewed article of this Preprint also exists.

Chou, N.-K.; Chou, H.-W.; Tsao, C.-I.; Wang, C.-H.; Chen, K.P.-H.; Chi, N.-H.; Huang, S.-C.; Yu, H.-Y.; Chen, Y.-S. Impact of the Pre-Transplant Circulatory Supportive Strategy on Post-Transplant Outcome: Double Bridge May Work. J. Clin. Med. 2021, 10, 4697. Chou, N.-K.; Chou, H.-W.; Tsao, C.-I.; Wang, C.-H.; Chen, K.P.-H.; Chi, N.-H.; Huang, S.-C.; Yu, H.-Y.; Chen, Y.-S. Impact of the Pre-Transplant Circulatory Supportive Strategy on Post-Transplant Outcome: Double Bridge May Work. J. Clin. Med. 2021, 10, 4697.

Journal reference: J. Clin. Med. 2021, 10, 4697
DOI: 10.3390/jcm10204697

Abstract

BACKGROUND: The number of waitlisted patients requiring mechanical circulatory support (MCS) as a bridge to heart transplantation is increasing. The data concerning the results of double-bridge strategy are limited. We sought to investigate the post-transplant outcomes across the different bridge strategies. METHODS: We retrospectively reviewed a heart transplantation database from Jan 2009 to Jan 2019. Intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO), and ventricular assist devices (VAD) were the MCS that we investigated. The pre- and post-transplant characteristics and variables of patients bridged with the different types of MCS were collected. The post-transplant survival was compared using Kaplan-Meier survival analysis. RESULTS: A total of 251 heart transplants were reviewed; 115 without MCS and 136 with MCS. The patients were divided to five groups: Group 1 (no MCS): n=115; Group 2 (IABP): n=15; Group 3 (ECMO): n=33; Group 4 (ECMO-VAD): double-bridge (n=59); Group 5 (VAD): n=29. Survival analysis demonstrated that the 3-year post-transplant survival rates were significantly different among the groups (Log-rank p < 0.001). There was no difference in survival between group 4(ECMO-VAD) and group 1(no MCS)1 (p = 0.136), or between group 4(ECMO-VAD) and group 5(VAD) (p = 0.994). Group 3(ECMO) had significantly inferior 3-year survival than group 4(ECMO-VAD) and group 5(VAD). CONCLUSION: Double bridge may not lead to worse mid-term results in patients who could receive a transplantation. Initial stabilization with ECMO for critical patients before implantation of VAD might be considered as a strategy for obtaining an optimal post-transplant outcome.

Keywords

mechanical circulatory support; heart transplantation; survival curve; ventricular assist device; extracorporeal membrane oxygenation

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