PMID- 37271752
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230823
IS  - 1738-5520 (Print)
IS  - 1738-5555 (Electronic)
IS  - 1738-5520 (Linking)
VI  - 53
IP  - 8
DP  - 2023 Aug
TI  - Comparison of Veno-arterial Extracorporeal Membrane Oxygenation Configurations 
      for Patients Listed for Heart Transplantation.
PG  - 535-547
LID - 10.4070/kcj.2022.0348 [doi]
AB  - BACKGROUND AND OBJECTIVES: Veno-arterial extracorporeal membrane oxygenation 
      (VA-ECMO) as a bridge to eventual heart transplantation (HT) is increasingly used 
      worldwide. However, the effect of different VA-ECMO types on HT outcomes remains 
      unclear. METHODS: This was a retrospective observational study of 111 patients 
      receiving VA-ECMO and awaiting HT. We assessed 3 ECMO configuration groups: 
      peripheral (n=76), central (n=12), and peripheral to central ECMO conversion 
      (n=23). Cox proportional hazards regression and landmark analysis were conducted 
      to analyze the effect of the ECMO configuration on HT and in-hospital mortality 
      rates. We also evaluated adverse events during ECMO support. RESULTS: HT was 
      performed in the peripheral (n=48, 63.2%), central (n=10, 83.3%), and conversion 
      (n=11, 47.8%) ECMO groups (p=0.133) with a median interval of 10.5, 16, and 30 
      days, respectively (p<0.001). The cumulative incidence of HT was significantly 
      lower in the conversion group (hazard ratio, 0.292, 95% confidence interval, 
      0.145-0.586, p=0.001). However, there was no difference in in-hospital mortality 
      (log-rank p=0.433). In the landmark analysis, in-hospital mortality did not 
      differ significantly among the 3 groups. Although we did note a trend toward 
      lower HT in the conversion group, the difference was not statistically 
      significant. Surgical site bleeding occurred mainly in the central, while limb 
      ischemia occurred mainly in the peripheral groups. CONCLUSIONS: We suggest that 
      if patients are being stably supported with their initial ECMO configuration, 
      whether it is central or peripheral, it should be maintained, and ECMO conversion 
      should only be cautiously performed when necessary.
CI  - Copyright (c) 2023. The Korean Society of Cardiology.
FAU - Hong, Jung Ae
AU  - Hong JA
AUID- ORCID: 0000-0003-3991-7353
AD  - Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, 
      University of Ulsan College of Medicine, Seoul, Korea.
AD  - Division of Cardiology, Department of Internal Medicine, Hallym Sacred Heart 
      Hospital, Hallym University College of Medicine, Anyang, Korea.
FAU - Kim, Ah-Ram
AU  - Kim AR
AUID- ORCID: 0000-0003-2489-948X
AD  - Division of Cardiology, Department of Internal Medicine, Asan Medical Center, 
      University of Ulsan College of Medicine, Seoul, Korea.
FAU - Kim, Min-Ju
AU  - Kim MJ
AUID- ORCID: 0000-0003-4600-5352
AD  - Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, 
      University of Ulsan College of Medicine, Seoul, Korea.
FAU - Pack, Dayoung
AU  - Pack D
AUID- ORCID: 0009-0004-8045-6506
AD  - Division of Cardiology, Department of Internal Medicine, Asan Medical Center, 
      University of Ulsan College of Medicine, Seoul, Korea.
FAU - Hyun, Junho
AU  - Hyun J
AUID- ORCID: 0000-0003-4211-3081
AD  - Division of Cardiology, Department of Internal Medicine, Asan Medical Center, 
      University of Ulsan College of Medicine, Seoul, Korea.
FAU - Lee, Sang Eun
AU  - Lee SE
AUID- ORCID: 0000-0002-7290-2463
AD  - Division of Cardiology, Department of Internal Medicine, Asan Medical Center, 
      University of Ulsan College of Medicine, Seoul, Korea.
FAU - Kim, Jae-Joong
AU  - Kim JJ
AUID- ORCID: 0000-0002-2714-2282
AD  - Division of Cardiology, Department of Internal Medicine, Asan Medical Center, 
      University of Ulsan College of Medicine, Seoul, Korea.
FAU - Kang, Pil Je
AU  - Kang PJ
AUID- ORCID: 0000-0002-7587-0911
AD  - Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, 
      University of Ulsan College of Medicine, Seoul, Korea.
FAU - Jung, Sung-Ho
AU  - Jung SH
AUID- ORCID: 0000-0002-3699-0312
AD  - Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, 
      University of Ulsan College of Medicine, Seoul, Korea.
FAU - Kim, Min-Seok
AU  - Kim MS
AUID- ORCID: 0000-0003-0860-3650
AD  - Division of Cardiology, Department of Internal Medicine, Asan Medical Center, 
      University of Ulsan College of Medicine, Seoul, Korea. msk@amc.seoul.kr.
LA  - eng
PT  - Journal Article
DEP - 20230517
PL  - Korea (South)
TA  - Korean Circ J
JT  - Korean circulation journal
JID - 101247141
PMC - PMC10435828
OTO - NOTNLM
OT  - Cardiac transplantation
OT  - Extracorporeal membrane oxygenation
OT  - Shock, cardiogenic
COIS- The authors have no financial conflicts of interest.
EDAT- 2023/06/05 00:42
MHDA- 2023/06/05 00:43
PMCR- 2023/08/01
CRDT- 2023/06/04 22:53
PHST- 2022/12/15 00:00 [received]
PHST- 2023/03/15 00:00 [revised]
PHST- 2023/04/04 00:00 [accepted]
PHST- 2023/06/05 00:43 [medline]
PHST- 2023/06/05 00:42 [pubmed]
PHST- 2023/06/04 22:53 [entrez]
PHST- 2023/08/01 00:00 [pmc-release]
AID - 53.e41 [pii]
AID - 10.4070/kcj.2022.0348 [doi]
PST - ppublish
SO  - Korean Circ J. 2023 Aug;53(8):535-547. doi: 10.4070/kcj.2022.0348. Epub 2023 May 
      17.