Impact of Temporary Percutaneous Mechanical Circulatory Support Before Transplantation in the 2018 Heart Allocation System

Kevin J. Clerkin, Oluwafeyijimi Salako, Justin A. Fried, Jan M. Griffin, Jayant Raikhelkar, Rashmi Jain, Susan Restaino, Paolo C. Colombo, Koji Takeda, Maryjane A. Farr, Gabriel Sayer, Nir Uriel, Veli K. Topkara

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objectives: This analysis sought to investigate the waitlist and post-transplant outcomes of individuals bridged to transplantation by using temporary percutaneous endovascular mechanical circulatory support (tMCS) through a status 2 designation (cardiogenic shock and exception). Background: The 2018 donor heart allocation policy change granted a status 2 designation to patients supported with tMCS. Methods: Adult patients in the United Network for Organ Sharing registry after October 18, 2018 who received a status 2 designation for tMCS were included and grouped by their status 2 criteria: cardiogenic shock with hemodynamic criteria (CS-HD), cardiogenic shock without hemodynamic criteria before tMCS (CS-woHD), and exception. Baseline characteristics, waitlist events (death and delisting), and post-transplant outcomes were compared. Results: A total of 2,279 patients met inclusion criteria: 68.6% (n = 1,564) with CS-HD, 3.2% (n = 73) with CS-woHD, and 28.2% (n = 642) with exceptions. A total of 64.2% of patients underwent heart transplantation within 14 days of status 2 listing or upgrade, and 1.9% died or were delisted for worsening clinical condition. Among the 35.8% who did not undergo transplantation following 14 days, only 2.8% went on to receive a left ventricular assist device (LVAD). The 30-day transplantation likelihood was similar among groups: 80.1% for the CS-HD group vs 79.7% for the exception group vs 73.3% for the CS-woHD group; P = 0.31. However, patients who met criteria for CS-woHD had 2.3-fold greater risk of death or delisting (95% CI: 1.10-4.75; P = 0.03) compared with CS-HD patients after multivariable adjustment. Pre-tMCS hemodynamics were not associated with adverse waitlist events. Conclusions: The use of tMCS is an efficient, safe, and effective strategy as a bridge to transplantation; however, patients with CS-woHD may represent a high-risk cohort. Transition to a durable LVAD was a rare event in this group.

Original languageEnglish (US)
Pages (from-to)12-23
Number of pages12
JournalJACC: Heart Failure
Volume10
Issue number1
DOIs
StatePublished - Jan 2022
Externally publishedYes

Keywords

  • 2018 allocation policy
  • UNOS
  • heart transplant
  • mechanical circulatory support
  • outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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