PMID- 36352776
OWN - NLM
STAT- MEDLINE
DCOM- 20230105
LR  - 20230111
IS  - 1540-8191 (Electronic)
IS  - 0886-0440 (Linking)
VI  - 37
IP  - 12
DP  - 2022 Dec
TI  - Lack of volume-outcome association in ECMO bridge to heart transplantation.
PG  - 4883-4890
LID - 10.1111/jocs.17157 [doi]
AB  - BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is 
      increasingly used as a bridge to cardiac transplantation. As the 2018 United 
      Network for Organ Sharing (UNOS) heart allocation policy change elevated waitlist 
      status for patients receiving mechanical circulatory support (MCS), we aimed to 
      determine if a center's annual heart transplant volume was associated with 
      ECMO-support duration and posttransplant outcomes. METHODS: Adults heart 
      transplant candidates between January 1, 2011, and December 31, 2021, were 
      isolated in the UNOS database. VA-ECMO use was identified at the time of listing 
      for transplant. Average annual transplant volume was calculated by the center, 
      with stratification as high (>/=20 cardiac transplants, high volume center [HVC]) 
      or low (<20 cardiac transplants, low volume center [LVC]) volume centers. Results 
      are reported as mean (interquartile range) or n (%). RESULTS: In total, 543 
      patients at HVCs and 275 at LVCs were listed for transplant supported with 
      VA-ECMO. Those listed at HVCs were more likely to be supported by intra-aortic 
      balloon pump (103 [19%] vs. 32 [11.6%], p = .008) and inotropes (267 [49.2%] vs. 
      106 [38.5%], p = .004) at time of listing. Patients at HVCs received ECMO support 
      for 6 [4-9] days, compared to 8 [4-15] days at low-volume centers (p = .030), and 
      but were cannulated a similar time before listing (2 [1-5] vs. 3 [1-7] days, 
      p = .517). There were no differences in rates of transplant (p = .2126), waitlist 
      mortality (p = .8645), delisting due to clinical deterioration (p = .8419), or 
      recovery (p = .1773) between groups. Among transplanted patients, there were no 
      differences in support duration (6 [4-8] vs. 6 [4-10], p = .187), or time from 
      registration to transplant (5 [2-20] vs. 7 [3-22] days, p = .560). Posttransplant 
      survival did not vary (p = .293). CONCLUSIONS: LVCs can successfully bridge 
      patients to transplant with VA-ECMO and achieve comparable outcomes to HVCs.
CI  - (c) 2022 Wiley Periodicals LLC.
FAU - Cohen, William G
AU  - Cohen WG
AD  - Perelman School of Medicine, University of Pennsylvania, Philadelphia, 
      Pennsylvania, USA.
FAU - Han, Jason
AU  - Han J
AD  - Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, 
      Philadelphia, Pennsylvania, USA.
FAU - Shin, Max
AU  - Shin M
AD  - Perelman School of Medicine, University of Pennsylvania, Philadelphia, 
      Pennsylvania, USA.
FAU - Iyengar, Amit
AU  - Iyengar A
AD  - Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, 
      Philadelphia, Pennsylvania, USA.
FAU - Wang, Xingmei
AU  - Wang X
AD  - Perelman School of Medicine at the University of Pennsylvania, Biostatistics 
      Analysis Center, Philadelphia, Pennsylvania, USA.
FAU - Helmers, Mark R
AU  - Helmers MR
AD  - Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, 
      Philadelphia, Pennsylvania, USA.
FAU - Cevasco, Marisa
AU  - Cevasco M
AD  - Perelman School of Medicine, University of Pennsylvania, Philadelphia, 
      Pennsylvania, USA.
AD  - Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, 
      Philadelphia, Pennsylvania, USA.
LA  - eng
PT  - Journal Article
DEP - 20221109
PL  - United States
TA  - J Card Surg
JT  - Journal of cardiac surgery
JID - 8908809
SB  - IM
MH  - Adult
MH  - Humans
MH  - *Extracorporeal Membrane Oxygenation/methods
MH  - Retrospective Studies
MH  - *Heart Transplantation
MH  - Time Factors
MH  - Intra-Aortic Balloon Pumping
OTO - NOTNLM
OT  - ECMO
OT  - bridge
OT  - outcomes
OT  - transplant
OT  - volume
EDAT- 2022/11/11 06:00
MHDA- 2023/01/06 06:00
CRDT- 2022/11/10 01:42
PHST- 2022/09/25 00:00 [received]
PHST- 2022/10/27 00:00 [accepted]
PHST- 2022/11/11 06:00 [pubmed]
PHST- 2023/01/06 06:00 [medline]
PHST- 2022/11/10 01:42 [entrez]
AID - 10.1111/jocs.17157 [doi]
PST - ppublish
SO  - J Card Surg. 2022 Dec;37(12):4883-4890. doi: 10.1111/jocs.17157. Epub 2022 Nov 9.