TITLE

Who needs ‘bridge’ to transplantation in the presence of the Eurotransplant high-urgency heart transplantation program?

AUTHOR(S)
Kamiya, Hiroyuki; Koch, Achim; Sack, Falk-Udo; Akhyari, Payam; Remppis, Andrew; Dengler, Thomas J.; Karck, Matthias; Lichtenberg, Artur
PUB. DATE
December 2008
SOURCE
European Journal of Cardio-Thoracic Surgery;Dec2008, Vol. 34 Issue 6, p1129
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Abstract: Introduction: The purposes of this study are to identify a patient cohort that would benefit from the use of mechanical circulatory support (MCS) in the presence of the Eurotransplant high-urgency (HU) program. Methods: Sixty-five patients (heart transplantation (HTx) group, 77%) underwent heart transplantation and 17 patients (D group, 20%) died while on the HU waiting list. These 82 patients were included in this retrospective study. Results: The mean waiting time on HU list was 18.3±17.7 days in HTx group and 12.5±9.4 days in D group (p =0.075). The average weekly allocation rate from the active HU list was 27.7%, and the mean weekly waiting-list mortality was 12.1%. The use of intra-aortic balloon pumping (p =0.005), mechanical ventilation (p =0.007), higher dose of dobutamine (0.005), lower serum level of sodium (p =0.046), and higher serum level of C reactive protein (CRP) (0.040) at the registration of HU listing were associated with waiting-time mortality, and the serum creatinine level more than 1.5mg/dl (p =0.007, odds ratio; 14.5, 95% CI; 2.1–102.0) and the serum CRP level more than 10mg/l (p =0.026, odds ratio; 6.3, 95%CI; 1.2–31.4) were identified as significant predictors. Conclusion: It would be appropriate that a patient who would not be able to tolerate one or two weeks waiting time to be considered as a candidate for MCS implantation in the presence of the HU program. The patient selection criteria for MCS implantation should include not only hemodynamic parameters, but also the aspect of a beginning multi-organ failure.
ACCESSION #
35327832

 

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