Venoarterial extracorporeal membrane oxygenation with or without simultaneous intra-aortic balloon pump support as a direct bridge to heart transplantation: results from a nationwide Spanish registry

Objectives: To investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT). Methods: We studied 169 patients who were listed for urgent HT under VA-EC...

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Detalles Bibliográficos
Autores: Barge-Caballero, Gonzalo, Castel-Lavilla, María A., Almenar-Bonet, Luis, Garrido-Bravo, Iris P., Delgado, Juan F., Rangel-Sousa, Diego, González-Costello, José, Segovia-Cubero, Javier, Farrero-Torres, Marta, Lambert-Rodríguez, José Luis, Crespo-Leiro, María G., Hervás-Sotomayor, Daniela, Portolés-Ocampo, Ana, Martínez-Sellés, Manuel, De la Fuente-Galán, Luis, Rábago-Juan-Aracil, Gregorio, González Vílchez, Francisco Jesús, Mirabet-Pérez, Sonia, Muñiz, Javier, Barge-Caballero, Eduardo
Tipo de recurso: artículo
Fecha de publicación:2019
País:España
Institución:Universidad de Cantabria (UC)
Repositorio:UCrea Repositorio Abierto de la Universidad de Cantabria
Idioma:inglés
OAI Identifier:oai:repositorio.unican.es:10902/36185
Acceso en línea:https://hdl.handle.net/10902/36185
Access Level:acceso abierto
Palabra clave:Heart transplantation
Extracorporeal membrane oxygenation
Intra-aortic balloon pump
Descripción
Sumario:Objectives: To investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT). Methods: We studied 169 patients who were listed for urgent HT under VA-ECMO support at 16 Spanish institutions from 2010 to 2015. The clinical outcomes of patients under simultaneous IABP support (n=73) were compared to a control group of patients without IABP support (n=96). Results: There were no statistically significant differences between the IABP and control groups with regard to the cumulative rates of transplantation (71.2% vs 81.2%, P=0.17), death during VA-ECMO support (20.6% vs 14.6%, P=0.31), transition to a different mechanical circulatory support device (5.5% vs 5.2%, P=0.94) or weaning from VA-ECMO support due to recovery (2.7% vs 0%, P=0.10). There was a higher incidence of bleeding events in the IABP group (45.2% vs 25%, P=0.006; adjusted odds ratio 2.18, 95% confidence interval 1.02-4.67). In-hospital postoperative mortality after HT was 34.6% in the IABP group and 32.5% in the control group (P=0.80). One-year survival after listing for urgent HT was 53.3% in the IABP group and 52.2% in the control group (log rank P=0.75). Multivariate adjustment for potential confounders did not change this result (adjusted hazard ratio 0.94, 95% confidence interval 0.56-1.58). Conclusions: In our study, simultaneous IABP therapy in transplant candidates under VA-ECMO support did not significantly reduce morbidity or mortality.

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