Advances in TransplantationCardiac TransplantationAcceptable Post–Heart Transplant Outcomes Support Temporary MCS Prioritization in the New OPTN|UNOS Heart Allocation Policy
Section snippets
Patient Population
During the years 2010 to 2017, a total of 728 heart transplants were performed in our institution and entered into a prospectively maintained heart transplant research database. The population was divided into 3 groups who went directly to heart transplant: patients bridged to transplant with temporary MCS, patients without MCS bridge, and patients bridged with durable MCS. The temporary MCS cohort included patients bridged to transplant with ECMO, percutaneous endovascular MCS, and/or IABP.
Results
Twenty-three patients were bridged to heart transplant using temporary MCS from 2010 to 2017 in our center. The temporary MCS pathways included Impella 5.0 (ABIOMED, Danvers, Mass, United States) (n = 5), intra-aortic balloon pump (n = 14), and venoarterial extracorporeal circulatory support (n = 4) (Table 2). Indications for temporary MCS were cardiogenic shock in the setting of multiorgan dysfunction or on mechanical ventilation to allow successful optimization of clinical status and
Discussion
In the 2018 International Society of Heart and Lung Transplantation registry report, a significant increase in patients bridged to heart transplant with MCS, predominantly as a result of an increase in left ventricular assist devices (LVADs), was identified, from 23.0% in years 2005 to 2008 to 43.9% in 2009 to 6/2017 (P < .001). In the 2009 to 6/2016 cohort of 30,824 registry patients, 1-year survival was 85.4%. MCS bridge to transplant did not adversely affect post-transplant survival, except
Conclusion
Bridging with temporary MCS devices achieves acceptable outcomes after heart transplant compared to 2 cohorts who now have lower priority in allocation: those not bridged with MCS and those bridged with durable MCS. These encouraging findings support increased priority and broader sharing for patients with temporary MCS in the new OPTN|UNOS adult heart allocation policy.
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2022, International Journal of CardiologyCitation Excerpt :Although the prioritization process of LVAD patients on the waiting list for HTx differs among countries, BTT patients without severe complications are facing an extremely long expected waiting time. Under the revised heart allocation system in the United States in October 2018, there has been a dramatic change in the bridging strategy, resulting in more patients being bridged with temporary devices, which places them in a high urgency waitlist [16,17]. As a result of this allocation policy change, BTT patients have a longer waitlist period to receive a donor heart, as they are now placed in a less urgent waitlist.