Recovery With Temporary Mechanical Circulatory Support While Waitlisted for Heart Transplantation.
Recovery With Temporary Mechanical Circulatory Support While Waitlisted for Heart Transplantation.
复制标题
DOI：
10.1016/j.jacc.2021.12.022
复制
发表时间：
2022-03-08
影响因子：
24
通讯作者：
Drakos SG
中科院分区：
文献类型：
--
作者：
Topkara VK;Sayer GT;Clerkin KJ;Wever-Pinzon O;Takeda K;Takayama H;Selzman CH;Naka Y;Burkhoff D;Stehlik J;Farr MA;Fang JC;Uriel N;Drakos SG
2018年美国心脏分配系统为最紧急的患者提供了心脏移植的加速途径。确定新的分配系统是否导致候选人恢复的可能性降低。纳入了2010年至2020年期间在UNOS登记处首次上市时等待临时MCS心脏移植的成年患者。在新与旧心脏分配系统中分析了心脏移植的竞争事件、等待名单死亡或因病情恶化而除名以及因病情改善而除名（候选恢复）。688例患者被列入VA-ECMO或外科不可出院BIVAD（状态1或旧1A）的等待名单。2237例患者等待接受IABP、经皮LVAD或手术不可放电LVAD（状态2或旧1A）。与旧心脏分配系统相比，VA-ECMO或不可出院BIVAD等待患者的中位等待时间显著缩短（5 vs. 31天），心脏移植发生率较高（81.5% vs. 43.0%），候选恢复发生率较低（1.5% vs. 7.9%）（所有p<0.05）。与旧心脏分配系统相比，接受IABP、经皮或不可放电LVAD的患者的中位等待时间也显著缩短（8 vs 35天），移植发生率较高（88.9% vs 64.9%），候选恢复发生率较低（0.2% vs 1.6%）（所有p<0.05）。新的分配制度可能无法为选定的临时MCS患者提供恢复到候补名单删除点的机会和足够的时间。进一步的研究将确定哪些患者将受益于紧急移植与恢复策略。2018年美国心脏分配系统为最紧急的患者提供了心脏移植的加速途径，但也可能限制康复的机会。对UNOS登记处中等待接受临时MCS心脏移植的成年患者进行了分析。新的心脏分配系统导致心脏移植的发生率增加，死亡/因临床状态恶化而退市的发生率降低。然而，在新的心脏分配系统中，候选回收的除名率显著较低（1.5%对7.9%）。新的分配系统可能无法为临时MCS患者提供恢复到候补名单删除点的机会和足够的时间。
The 2018 United States heart allocation system offers an accelerated pathway for heart transplantation to the most urgent patients. To determine whether the new allocation system resulted in lower likelihood of candidate recovery. Adult patients waitlisted for heart transplantation with temporary MCS at the time of initial listing between 2010 and 2020 in the UNOS registry were included. Competing events of heart transplantation, waitlist death or delisting for deteriorating condition, and delisting for improved condition (candidate recovery) were analyzed in the new versus old heart allocation system. 688 patients were waitlisted with VA-ECMO or surgical non-dischargeable BIVAD (Status 1 or old 1A). 2237 patients were waitlisted with IABP, percutaneous LVAD, or surgical non-dischargeable LVAD (Status 2 or old 1A). Patients waitlisted with VA-ECMO or non-dischargeable BIVAD had significantly shorter median waitlist times (5 vs. 31 days), higher incidence for cardiac transplantation (81.5% vs. 43.0%), and lower incidence of candidate recovery (1.5% vs. 7.9%) in the new vs. old heart allocation system (all p<0.05). Patients waitlisted with IABP, percutaneous or non-dischargeable LVAD also had significantly shorter median waitlist times (8 vs. 35 days), higher incidence of transplantation (88.9% vs. 64.9%), and lower incidence of candidate recovery (0.2% vs. 1.6%) in the new vs. old heart allocation system (all p<0.05). The new allocation system may not offer select temporary MCS patients the opportunity and adequate time to recover to the point of waitlist removal. Further research will determine which patients would benefit from urgent transplantation versus recovery strategy. The 2018 United States heart allocation system offers an accelerated pathway for heart transplantation to the most urgent patients but could also limit chances of recovery. Adult patients waitlisted for heart transplantation with temporary MCS in the UNOS registry were analyzed. New heart allocation system resulted in increased incidence of heart transplantation and decreased incidence of death/delisting for worsening clinical status. However, delisting for candidate recovery was significantly lower in the new heart allocation system (1.5% vs.7.9%). The new allocation system may not offer temporary MCS patients the opportunity and adequate time to recover to the point of waitlist removal.
登录
查看更多内容
影响因子：
37.8
作者：
Birks, Emma J.;Drakos, Stavros G.;Rame, Jesus E.
通讯作者：
Rame, Jesus E.
影响因子：
24
作者：
Wever-Pinzon, Omar;Drakos, Stavros G.;Selzman, Craig H.
通讯作者：
Selzman, Craig H.
影响因子：
8.8
作者：
Goff, Rebecca R.;Uccellini, Kimberly;Rogers, Joseph G.
通讯作者：
Rogers, Joseph G.
影响因子：
24
作者：
Varshney, Anubodh S.;Berg, David D.;Morrow, David A.
通讯作者：
Morrow, David A.
影响因子：
4.6
作者：
Cheng, Yi-Tso;Garan, Arthur R.;Takeda, Koji
通讯作者：
Takeda, Koji