Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplant—Change of Paradigm

Scientific paper - Review paper

• Author: Dubravka Šipuš; MBZ: 155684
• Author: Kristina Krželj
• Author: Željko Đurić
• Author: Hrvoje Gašparović
• Author: Davor Miličić
• Author: Jadranka Šeparović Hanževački
• Author: Daniel Lovrić
• Author's institution: University of Zagreb; School of Medicine; (Department of Internal Medicine)
• Author's institution: University of Zagreb; School of Medicine; (Department of Surgery)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract (english)

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.

• Keywords (english): extracorporeal membrane oxygenation; heart failure; heart transplantation
• Language: english
• Publication type: Scientific paper - Review paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Journal of Clinical Medicine
• Numbering: vol. 11, no. 23, 7101
• e-ISSN: 2077-0383
• DOI: https://doi.org/10.3390/jcm11237101
• URN:NBN: urn:nbn:hr:105:131775
• Publication: 2022-11-30
• Document URL: https://www.mdpi.com/2077-0383/11/23/7101
• Type of resource: Text
• Access conditions: Open access
• Created on: 2023-05-17 12:04:53