Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant—Change of Paradigm
Despite advances in medical therapy and mechanical circulatory support (MCS), heart transplant (HT) remains the gold standard therapy for end-stage heart failure. Patients in cardiogenic shock require prompt intervention to reverse hypoperfusion and end-organ damage. When medical therapy becomes ins...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/23/7101 |
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| author | Dubravka Šipuš Kristina Krželj Željko Đurić Hrvoje Gašparović Davor Miličić Jadranka Šeparović Hanževački Daniel Lovrić |
| author_facet | Dubravka Šipuš Kristina Krželj Željko Đurić Hrvoje Gašparović Davor Miličić Jadranka Šeparović Hanževački Daniel Lovrić |
| author_sort | Dubravka Šipuš |
| collection | DOAJ |
| description | Despite advances in medical therapy and mechanical circulatory support (MCS), heart transplant (HT) remains the gold standard therapy for end-stage heart failure. Patients in cardiogenic shock require prompt intervention to reverse hypoperfusion and end-organ damage. When medical therapy becomes insufficient, MCS should be considered. Historically, it has been reported that critically ill patients bridged with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) directly to HT have worse outcomes. However, when the heart allocation system gives the highest priority to patients on VA-ECMO support, those patients have a higher incidence of HT and a lower incidence of death or removal from the transplant list. Moreover, patients with a short waiting time on VA-ECMO have a similar hazard of mortality to non-ECMO patients. According to the reported data, bridging with VA-ECMO directly to HT may be a solution in the selection of critically ill patients when the anticipated waiting list time is short. However, when a prolonged waiting time is expected, more durable MCS should be considered. Regardless of the favorable results of the direct bridging to HT with ECMO in selected patients, the superiority of this strategy compared to the bridge-to-bridge strategy (ECMO to durable MCS) has not been established and further studies are mandatory in order to clarify this issue. |
| first_indexed | 2024-03-09T17:43:42Z |
| format | Article |
| id | doaj.art-8c63e710ccb44e1dbcebd095cc5ed526 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T17:43:42Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-8c63e710ccb44e1dbcebd095cc5ed5262023-11-24T11:22:56ZengMDPI AGJournal of Clinical Medicine2077-03832022-11-011123710110.3390/jcm11237101Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant—Change of ParadigmDubravka Šipuš0Kristina Krželj1Željko Đurić2Hrvoje Gašparović3Davor Miličić4Jadranka Šeparović Hanževački5Daniel Lovrić6Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, CroatiaDepartment of Cardiac Surgery, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, CroatiaDepartment of Cardiac Surgery, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, CroatiaDepartment of Cardiac Surgery, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, CroatiaDepartment of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, CroatiaDepartment of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, CroatiaDepartment of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, CroatiaDespite advances in medical therapy and mechanical circulatory support (MCS), heart transplant (HT) remains the gold standard therapy for end-stage heart failure. Patients in cardiogenic shock require prompt intervention to reverse hypoperfusion and end-organ damage. When medical therapy becomes insufficient, MCS should be considered. Historically, it has been reported that critically ill patients bridged with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) directly to HT have worse outcomes. However, when the heart allocation system gives the highest priority to patients on VA-ECMO support, those patients have a higher incidence of HT and a lower incidence of death or removal from the transplant list. Moreover, patients with a short waiting time on VA-ECMO have a similar hazard of mortality to non-ECMO patients. According to the reported data, bridging with VA-ECMO directly to HT may be a solution in the selection of critically ill patients when the anticipated waiting list time is short. However, when a prolonged waiting time is expected, more durable MCS should be considered. Regardless of the favorable results of the direct bridging to HT with ECMO in selected patients, the superiority of this strategy compared to the bridge-to-bridge strategy (ECMO to durable MCS) has not been established and further studies are mandatory in order to clarify this issue.https://www.mdpi.com/2077-0383/11/23/7101extracorporeal membrane oxygenationheart transplantationheart failure |
| spellingShingle | Dubravka Šipuš Kristina Krželj Željko Đurić Hrvoje Gašparović Davor Miličić Jadranka Šeparović Hanževački Daniel Lovrić Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant—Change of Paradigm Journal of Clinical Medicine extracorporeal membrane oxygenation heart transplantation heart failure |
| title | Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant—Change of Paradigm |
| title_full | Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant—Change of Paradigm |
| title_fullStr | Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant—Change of Paradigm |
| title_full_unstemmed | Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant—Change of Paradigm |
| title_short | Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant—Change of Paradigm |
| title_sort | veno arterial extracorporeal membrane oxygenation as a bridge to heart transplant change of paradigm |
| topic | extracorporeal membrane oxygenation heart transplantation heart failure |
| url | https://www.mdpi.com/2077-0383/11/23/7101 |
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