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Article

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

1
Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei 100, Taiwan
2
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
3
Department of Nursing, National Taiwan University Hospital, Taipei 100, Taiwan
4
School of Medicine, Auckland University, Auckland 1023, New Zealand
5
College of Medicine, National Taiwan University, Taipei 100, Taiwan
6
Cardiovascular Center, National Taiwan University Hospital, Taipei 100, Taiwan
*
Author to whom correspondence should be addressed.
These authors contribute equally.
Academic Editor: Rabea Asleh
J. Clin. Med. 2021, 10(20), 4697; https://doi.org/10.3390/jcm10204697
Received: 4 September 2021 / Revised: 8 October 2021 / Accepted: 9 October 2021 / Published: 13 October 2021
(This article belongs to the Special Issue Current Challenges and Advances in Heart Failure and Heart Transplant)
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 the 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. View Full-Text
Keywords: mechanical circulatory support; heart transplantation; survival curve; ventricular assist device; extracorporeal membrane oxygenation; timing mechanical circulatory support; heart transplantation; survival curve; ventricular assist device; extracorporeal membrane oxygenation; timing
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MDPI and ACS Style

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. https://doi.org/10.3390/jcm10204697

AMA Style

Chou N-K, Chou H-W, Tsao C-I, Wang C-H, Chen KP-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. Journal of Clinical Medicine. 2021; 10(20):4697. https://doi.org/10.3390/jcm10204697

Chicago/Turabian Style

Chou, Nai-Kuan, Heng-Wen Chou, Chuan-I Tsao, Chih-Hsien Wang, Kevin P.-H. Chen, Nai-Hsin Chi, Shu-Chien Huang, Hsi-Yu Yu, and Yih-Sharng Chen. 2021. "Impact of the Pre-Transplant Circulatory Supportive Strategy on Post-Transplant Outcome: Double Bridge May Work" Journal of Clinical Medicine 10, no. 20: 4697. https://doi.org/10.3390/jcm10204697

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