| Worse postoperative outcomes
for critically ill patients bridged to urgent heart transplantation
with VADs than with conventional therapy Postoperative outcomes of severe heart failure patients bridged with short-term VADs to urgent (〜 status UNOS 1A) heart transplantation are significantly worse than those of patients bridged with conventional support, recent data of the Spanish National Heart Transplant Registry suggest according to a presentation at the 2011 European Society of Cardiology Congress. Spanish investigators led by Drs. Eduardo Barge-Caballero and Marisa Crespo-Leiro from the Hospital Universitario A Coruna conducted a multi-institutional retrospective study of 704 patients with critical heart failure, who underwent urgent, high-priority heart transplantation in 15 Spanish hospitals from January 2000 to December 2009. One hundred and seven patients had been supported with short-term VADs before transplantation, while the remaining 597 had been bridged with conventional therapy that included intravenous inotropes, invasive mechanical ventilation and/or intraaortic balloon pump. Implanted VADs were paracorporeal pulsatile-flow devices in 58 cases and extracorporeal continuous-flow ones in 47. Interestingly, mean waiting list time was extremely short, around 5 days, a characteristic fact of the well-organized Spanish high-emergency organ procurement and allocation system. Despite fairly similar pre-transplant clinical status and end-organ function, VAD bridged patients showed a higher incidence of severe surgical bleeding, longer bypass times and higher rates of primary graft failure than conventionally bridged patients, resulting in a significantly reduced post-transplant survival. In Dr. Barge-Caballero´s opinion, "our data suggest that routine
short-term VAD implantation in stable patients awaiting high-emergency
heart transplantation should not be recommended, at least in countries
with expected short waiting list times, as this strategy might compromise
heart transplant outcomes". For the main investigator of the
study, "short-term VAD support as a bridge to high-emergency
heart transplantation should be reserved for critically ill patients
with a deteriorating hemodynamic status, in which conventional therapy
is not enough to ensure adequate peripheral perfusion and to avoid
irreversible end-organ damage". |