Venoarterial extracorporeal membrane oxygenation with or without simultaneous intra-aortic balloon pump support as a direct bridge to heart transplantation: results from a nationwide Spanish registry
Barge-Caballero G (1,2), Castel-Lavilla MA (3), Almenar-Bonet L (4), Garrido-Bravo IP (2,5), Delgado JF (2,6), Rangel-Sousa D (7), González-Costello J (8), Segovia-Cubero J (2,9), Farrero-Torres M (3), Lambert-Rodríguez JL (10,11), Crespo-Leiro MG (1,2), Hervás-Sotomayor D (12), Portolés-Ocampo A (13), Martínez-Sellés M (2,14), De la Fuente-Galán L (2,15), Rábago-Juan-Aracil G (16), González-Vílchez F (17), Mirabet-Pérez S (18), Muñiz J (2,19), Barge-Caballero E (1,2).
(1) Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
(2) Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
(3) Hospital Clinic i Provincial, Barcelona, Spain.
(4) Hospital Universitario y Politécnico La Fe, Valencia, Spain.
(5) Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
(6) Hospital Universitario Doce de Octubre, Instituto de Investigación i+12, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
(7) Hospital Universitario Virgen del Rocío, Sevilla, Spain.
(8) Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain.
(9) Hospital Universitario Puerta de Hierro, Majadahonda, Spain.
(10) Hospital Universitario Central de Asturias, Oviedo, Spain.
(11) Universidad Católica San Antonio, Murcia, Spain.
(12) Hospital Universitario Reina Sofía, Córdoba, Spain.
(13) Hospital Universitario Miguel Servet, Zaragoza, Spain.
(14) Hospital General Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, Spain.
(15) Hospital Clínico Universitario, Valladolid, Spain.
(16) Clínica Universidad de Navarra, Pamplona, Spain.
(17) Hospital Universitario Marqués de Valdecilla, Santander, Spain.
(18) Hospital Santa Creu i Sant Pau, Barcelona, Spain.
(19) Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña (UDC), INIBIC, A Coruña, Spain.
Magazine: Interactive Cardiovascular and Thoracic Surgery
Date: Jun 30, 2019Cardiac Surgery [SP]
To investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT).
We studied 169 patients who were listed for urgent HT under VA-ECMO support at 16 Spanish institutions from 2010 to 2015. The clinical outcomes of patients under simultaneous IABP support (n = 73) were compared to a control group of patients without IABP support (n = 96).
There were no statistically significant differences between the IABP and control groups with regard to the cumulative rates of transplantation (71.2% vs 81.2%, P = 0.17), death during VA-ECMO support (20.6% vs 14.6%, P = 0.31), transition to a different mechanical circulatory support device (5.5% vs 5.2%, P = 0.94) or weaning from VA-ECMO support due to recovery (2.7% vs 0%, P = 0.10). There was a higher incidence of bleeding events in the IABP group (45.2% vs 25%, P = 0.006; adjusted odds ratio 2.18, 95% confidence interval 1.02-4.67). In-hospital postoperative mortality after HT was 34.6% in the IABP group and 32.5% in the control group (P = 0.80). One-year survival after listing for urgent HT was 53.3% in the IABP group and 52.2% in the control group (log rank P = 0.75). Multivariate adjustment for potential confounders did not change this result (adjusted hazard ratio 0.94, 95% confidence interval 0.56-1.58).
In our study, simultaneous IABP therapy in transplant candidates under VA-ECMO support did not significantly reduce morbidity or mortality.
CITATION Interact Cardiovasc Thorac Surg. 2019 Jun 30. pii: ivz155. doi: 10.1093/icvts/ivz155
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