Who needs 'bridge' to transplantation in the presence of the Eurotransplant high-urgency heart transplantation program?
BACKGROUND
The purposes of this study are to identify a patient cohort that would benefit from the use of mechanical circulatory support (MCS) in the presence of the Eurotransplant high-urgency (HU) program.


METHODS
Sixty-five patients (heart transplantation (HTx) group, 77%) underwent heart transplantation and 17 patients (D group, 20%) died while on the HU waiting list. These 82 patients were included in this retrospective study.


RESULTS
The mean waiting time on HU list was 18.3+/-17.7 days in HTx group and 12.5+/-9.4 days in D group (p=0.075). The average weekly allocation rate from the active HU list was 27.7%, and the mean weekly waiting-list mortality was 12.1%. The use of intra-aortic balloon pumping (p=0.005), mechanical ventilation (p=0.007), higher dose of dobutamine (0.005), lower serum level of sodium (p=0.046), and higher serum level of C reactive protein (CRP) (0.040) at the registration of HU listing were associated with waiting-time mortality, and the serum creatinine level more than 1.5mg/dl (p=0.007, odds ratio; 14.5, 95% CI; 2.1-102.0) and the serum CRP level more than 10mg/l (p=0.026, odds ratio; 6.3, 95%CI; 1.2-31.4) were identified as significant predictors.


CONCLUSIONS
It would be appropriate that a patient who would not be able to tolerate one or two weeks waiting time to be considered as a candidate for MCS implantation in the presence of the HU program. The patient selection criteria for MCS implantation should include not only hemodynamic parameters, but also the aspect of a beginning multi-organ failure.
Kamiya
Hiroyuki
H
Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany. hiroyuki.kamiya@med.uni-heidelberg.de
Koch
Achim
A
Sack
Falk-Udo
FU
Akhyari
Payam
P
Remppis
Andrew
A
Dengler
Thomas J
TJ
Karck
Matthias
M
Lichtenberg
Artur
A
D000328:Adult; D001243:Assisted Circulation / Q000706:statistics & numerical data*; D002423:Cause of Death; D016009:Chi-Square Distribution; D005060:Europe; D005260:Female; D006331:Heart Diseases / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012306:Risk; D009927:Tissue and Organ Procurement / Q000379:methods*; D014850:Waiting Lists