UNASSIGNED:我们比较了移植前从临时机械循环支持桥接到耐用左心室辅助装置的患者(桥对桥[BTB]策略)和从临时机械循环支持直接桥接到移植的患者(桥对移植[BTT]策略)的移植后结果。
UNASSIGNED:我们在2005年至2020年的器官采购和移植网络数据库中确定了接受体外膜氧合支持的成年心脏移植受者,主动脉内球囊泵,或临时心室辅助装置作为BTB或BTT策略。Kaplan-Meier生存分析和Cox回归用于评估1年,5年,和10年的生存。比较移植后住院时间和并发症作为次要结局。
未经批准:总共,201体外膜氧合(61BTB,140BTT),1385主动脉内球囊反搏(460BTB,925BTT),和234临时心室辅助装置(75BTB,确定了159例BTT)患者。对于支持体外膜氧合的患者,主动脉内球囊泵,或临时心室辅助装置,移植后1年和5年,BTB和BTT之间的生存率没有差异,以及移植后10年,即使在调整基线特征后。体外膜氧合BTB组的急性排斥发生率更高(32.8%vs13.6%;P=0.002),透析发生率更低(1.6%vs21.4%;P<.001)。对于主动脉内球囊泵和临时心室辅助装置患者,移植后的住院时间没有差异,急性排斥反应,气道损害,中风,透析,或在BTB和BTT接受者之间插入起搏器。
未经证实:BTB患者移植后短期和中期生存率与BTT患者相似。未来的研究应继续研究长期的临时机械循环支持与过渡到持久的机械循环支持之间的权衡。
UNASSIGNED: We compared posttransplant outcomes between patients bridged from temporary mechanical circulatory support to durable left ventricular assist device before transplant (bridge-to-bridge [BTB] strategy) and patients bridged from temporary mechanical circulatory support directly to transplant (bridge-to-transplant [BTT] strategy).
UNASSIGNED: We identified adult heart transplant recipients in the Organ Procurement and Transplantation Network database between 2005 and 2020 who were supported with extracorporeal membrane oxygenation, intra-aortic balloon pump, or temporary ventricular assist device as a BTB or BTT strategy. Kaplan-Meier survival analysis and Cox regressions were used to assess 1-year, 5-year, and 10-year survival. Posttransplant length of stay and complications were compared as secondary outcomes.
UNASSIGNED: In total, 201 extracorporeal membrane oxygenation (61 BTB, 140 BTT), 1385 intra-aortic balloon pump (460 BTB, 925 BTT), and 234 temporary ventricular assist device (75 BTB, 159 BTT) patients were identified. For patients supported with extracorporeal membrane oxygenation, intra-aortic balloon pump, or temporary ventricular assist device, there were no differences in survival between BTB and BTT at 1 and 5 years posttransplant, as well as 10 years posttransplant even after adjusting for baseline characteristics. The extracorporeal membrane oxygenation BTB group had greater rates of acute rejection (32.8% vs 13.6%; P = .002) and lower rates of dialysis (1.6% vs 21.4%; P < .001). For intra-aortic balloon pump and temporary ventricular assist device patients, there were no differences in posttransplant length of stay, acute rejection, airway compromise, stroke, dialysis, or pacemaker insertion between BTB and BTT recipients.
UNASSIGNED: BTB patients have similar short- and midterm posttransplant survival as BTT patients. Future studies should continue to investigate the tradeoff between prolonged temporary mechanical circulatory support versus transitioning to durable mechanical circulatory support.