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Article

Comparative Temporal Analysis of Morbidity and Early Mortality in Heart Transplantation with Extracorporeal Membrane Oxygenation Support: Exploring Trends over Time

by
Raquel López-Vilella
1,2,*,
Manuel Pérez Guillén
3,
Borja Guerrero Cervera
2,
Ricardo Gimeno Costa
4,
Iratxe Zarragoikoetxea Jauregui
5,
Francisca Pérez Esteban
4,
Paula Carmona
5,
Tomás Heredia Cambra
3,
Mónica Talavera Peregrina
4,
Azucena Pajares Moncho
5,
Carlos Domínguez-Massa
3,
Víctor Donoso Trenado
1,2,
Luis Martínez Dolz
2,6,
Pilar Argente
5,
Álvaro Castellanos
4,
Juan Martínez León
3,
Salvador Torregrosa Puerta
3 and
Luis Almenar Bonet
1,2,6
1
Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
2
Cardiology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
3
Cardiovascular Surgery Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
4
Intensive Care Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
5
Department of Anesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
6
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
*
Author to whom correspondence should be addressed.
Biomedicines 2024, 12(9), 2109; https://doi.org/10.3390/biomedicines12092109
Submission received: 7 August 2024 / Revised: 3 September 2024 / Accepted: 8 September 2024 / Published: 16 September 2024
(This article belongs to the Special Issue Acute and Chronic Heart Failure: Pathophysiology and New Therapeutic Developments)
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Abstract

Background/Objectives: The direct bridge to urgent heart transplant (HT) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support has been associated with high morbidity and mortality. The objective of this study is to analyze the morbidity and mortality of patients transplanted with VA-ECMO and compare the presumed differences between various eras over a 17-year timeline. Methods: This is a prospective, observational study on consecutive patients stabilized with VA-ECMO and transplanted with VA-ECMO from July 2007 to December 2023 at a reference center (98 patients). Objective variables were mortality and morbidity from renal failure, venous thromboembolic disease (VTD), primary graft dysfunction (PGD), the need for tracheostomy, severe myopathy, reoperation, post-transplant ECMO, vascular complications, and sepsis/infection. Results: The percentage of patients who reached transplantation without the need for mechanical ventilation has increased over the periods studied. No significant differences were found between the study periods in 30-day mortality (p = 0.822), hospital discharge (p = 0.972), one-year mortality (p = 0.706), or five-year mortality (p = 0.797). Survival rates in these periods were 84%, 75%, 64%, and 61%, respectively. Comorbidities were very frequent, with an average of 3.33 comorbidities per patient. The most frequent were vascular complications (58%), the need for post-transplant ECMO (57%), and myopathy (55%). The development of myopathy and the need for post-transplant ECMO were higher in recent periods (p = 0.004 and p = 0.0001, respectively). Conclusions: VA-ECMO support as a bridge to HT allows hospital discharge for 3 out of 4 transplanted patients. This survival rate has not changed over the years. The comorbidities associated with this device are frequent and significant.
Keywords: urgent heart transplantation; venoarterial extracorporeal membrane oxygenation; morbidity; mortality; eras urgent heart transplantation; venoarterial extracorporeal membrane oxygenation; morbidity; mortality; eras

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MDPI and ACS Style

López-Vilella, R.; Pérez Guillén, M.; Guerrero Cervera, B.; Gimeno Costa, R.; Zarragoikoetxea Jauregui, I.; Pérez Esteban, F.; Carmona, P.; Heredia Cambra, T.; Talavera Peregrina, M.; Pajares Moncho, A.; et al. Comparative Temporal Analysis of Morbidity and Early Mortality in Heart Transplantation with Extracorporeal Membrane Oxygenation Support: Exploring Trends over Time. Biomedicines 2024, 12, 2109. https://doi.org/10.3390/biomedicines12092109

AMA Style

López-Vilella R, Pérez Guillén M, Guerrero Cervera B, Gimeno Costa R, Zarragoikoetxea Jauregui I, Pérez Esteban F, Carmona P, Heredia Cambra T, Talavera Peregrina M, Pajares Moncho A, et al. Comparative Temporal Analysis of Morbidity and Early Mortality in Heart Transplantation with Extracorporeal Membrane Oxygenation Support: Exploring Trends over Time. Biomedicines. 2024; 12(9):2109. https://doi.org/10.3390/biomedicines12092109

Chicago/Turabian Style

López-Vilella, Raquel, Manuel Pérez Guillén, Borja Guerrero Cervera, Ricardo Gimeno Costa, Iratxe Zarragoikoetxea Jauregui, Francisca Pérez Esteban, Paula Carmona, Tomás Heredia Cambra, Mónica Talavera Peregrina, Azucena Pajares Moncho, and et al. 2024. "Comparative Temporal Analysis of Morbidity and Early Mortality in Heart Transplantation with Extracorporeal Membrane Oxygenation Support: Exploring Trends over Time" Biomedicines 12, no. 9: 2109. https://doi.org/10.3390/biomedicines12092109

APA Style

López-Vilella, R., Pérez Guillén, M., Guerrero Cervera, B., Gimeno Costa, R., Zarragoikoetxea Jauregui, I., Pérez Esteban, F., Carmona, P., Heredia Cambra, T., Talavera Peregrina, M., Pajares Moncho, A., Domínguez-Massa, C., Donoso Trenado, V., Martínez Dolz, L., Argente, P., Castellanos, Á., Martínez León, J., Torregrosa Puerta, S., & Almenar Bonet, L. (2024). Comparative Temporal Analysis of Morbidity and Early Mortality in Heart Transplantation with Extracorporeal Membrane Oxygenation Support: Exploring Trends over Time. Biomedicines, 12(9), 2109. https://doi.org/10.3390/biomedicines12092109

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