Short-Term Mechanical Circulatory Support Before Heart Transplantation and Early Outcomes: Insights From the International Primary Graft Dysfunction Consortium.
Heart transplantation (HT) remains the gold-standard therapy for selected patients with advanced heart failure. Increasing recipient complexity and donor organ scarcity have led to the increased use of short-term mechanical circulatory support (ST-MCS) as a bridge to HT. The prognostic impact of ST-MCS on primary graft dysfunction (PGD) and other early outcomes remains limited.
We analyzed data from the Primary Graft Dysfunction Consortium, a retrospective registry including 3800 adult HTs at 14 centers in the United States, Canada, and Europe between 2010 and 2020. Primary outcomes were severe PGD (according to International Society for Heart and Lung Transplantation criteria) and 1-year mortality. Multivariable logistic regression and Cox models were used, with multiple imputation for missingness.
Overall, 669 patients (17.6%) received pre-HT ST-MCS. Among them, 16.9% were supported with extracorporeal membrane oxygenation (ECMO), 60.4% with an intra-aortic balloon pump, 9.1% with a percutaneous left ventricular assist device, 9.1% with surgical ventricular assist devices, and 4.5% with other devices. ST-MCS use increased over time and varied by region, with the intra-aortic balloon pump predominating in the United States and ECMO more frequently used in Canada and Europe. Overall, ST-MCS was not associated with severe PGD after adjustment; however, ECMO was independently associated with greater PGD risk (adjusted odds ratio 3.28, 95% confidence interval 1.90-5.66). One-year mortality was 11.0% and did not differ significantly according to ST-MCS use after multivariable adjustment.
In this large contemporary multinational cohort, pretransplant ST-MCS use has increased, with geographic heterogeneity observed. Although ECMO is associated with a greater risk of severe PGD, ST-MCS does not independently increase 1-year mortality after HT, supporting its use as a bridge in high-risk patients.
We analyzed data from the Primary Graft Dysfunction Consortium, a retrospective registry including 3800 adult HTs at 14 centers in the United States, Canada, and Europe between 2010 and 2020. Primary outcomes were severe PGD (according to International Society for Heart and Lung Transplantation criteria) and 1-year mortality. Multivariable logistic regression and Cox models were used, with multiple imputation for missingness.
Overall, 669 patients (17.6%) received pre-HT ST-MCS. Among them, 16.9% were supported with extracorporeal membrane oxygenation (ECMO), 60.4% with an intra-aortic balloon pump, 9.1% with a percutaneous left ventricular assist device, 9.1% with surgical ventricular assist devices, and 4.5% with other devices. ST-MCS use increased over time and varied by region, with the intra-aortic balloon pump predominating in the United States and ECMO more frequently used in Canada and Europe. Overall, ST-MCS was not associated with severe PGD after adjustment; however, ECMO was independently associated with greater PGD risk (adjusted odds ratio 3.28, 95% confidence interval 1.90-5.66). One-year mortality was 11.0% and did not differ significantly according to ST-MCS use after multivariable adjustment.
In this large contemporary multinational cohort, pretransplant ST-MCS use has increased, with geographic heterogeneity observed. Although ECMO is associated with a greater risk of severe PGD, ST-MCS does not independently increase 1-year mortality after HT, supporting its use as a bridge in high-risk patients.
Authors
Rivas-Lasarte Rivas-Lasarte, Rodenas-Alesina Rodenas-Alesina, Moayedi Moayedi, Truby Truby, Foroutan Foroutan, Henricksen Henricksen, Signorile Signorile, Dhingra Dhingra, Hastenteufel Hastenteufel, Fan Fan, Guzman-Bofarull Guzman-Bofarull, Farrero-Torres Farrero-Torres, Khush Khush, Couto-Mallon Couto-Mallon, Moayedifar Moayedifar, Kim Kim, Crespo-Leiro Crespo-Leiro, Chih Chih, Devore Devore, Takeda Takeda, Lerman Lerman, Sabatino Sabatino, Potena Potena, Tremblay-Gravel Tremblay-Gravel, Noly Noly, Miller Miller, Zuckermann Zuckermann, Farr Farr, Ross Ross, Martin Martin, Segovia-Cubero Segovia-Cubero, Hall Hall
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