title: Impact of short-term mechanical circulatory support with extracorporeal devices on postoperative outcomes after emergency heart transplantation: data from a multi-institutional Spanish cohort.
abstract: OBJECTIVE
  We sought to investigate the potential impact of preoperative short-term mechanical circulatory support (MCS) with extracorporeal devices on postoperative outcomes after emergency heart transplantation (HT).
  
  
  METHODS
  We conducted an observational study of 669 patients who underwent emergency HT in 15 Spanish hospitals between 2000 and 2009. Postoperative outcomes of patients bridged to HT on short-term MCS (n=101) were compared with those of the rest of the cohort (n=568). Short-term MCS included veno-arterial extracorporeal membrane oxygenators (VA-ECMOs, n=23), and both pulsatile-flow (n=53) and continuous-flow (n=25) extracorporeal ventricular assist devices (VADs). No patient underwent HT on intracorporeal VADs.
  
  
  RESULTS
  Preoperative short-term MCS was independently associated with increased in-hospital postoperative mortality (adjusted odds-ratio 1.75, 95% CI 1.05-2.91) and overall post-transplant mortality (adjusted hazard-ratio 1.60, 95% CI 1.15-2.23). Rates of major surgical bleeding, cardiac reoperation, postoperative infection and primary graft failure were also significantly higher among MCS patients. Causes of death and survival after hospital discharge were similar in MCS and non-MCS candidates. Increased risk of post-transplant mortality affected patients bridged on pulsatile-flow extracorporeal VADs (adjusted hazard-ratio 2.21, 95% CI 1.48-3.30) and continuous-flow extracorporeal VADs (adjusted hazard-ratio 2.24, 95% CI 1.20-4.19), but not those bridged on VA-ECMO (adjusted hazard-ratio 0.51, 95% CI 0.21-1.25).
  
  
  CONCLUSIONS
  Patients bridged to emergency HT on short-term MCS are exposed to an increased risk of postoperative complications and mortality. In our series, preoperative bridging with VA-ECMO resulted in comparable post-transplant outcomes to those of patients transplanted on conventional support.
authors.affiliation: Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain. Electronic address: eduardo.barge.caballero@sergas.es.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barge-Caballero
authors.affiliation: Hospital Universitario Politécnico La Fe. Valencia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Almenar-Bonet
authors.affiliation: Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Villa-Arranz
authors.affiliation: Hospital Clinic i Provincial, Barcelona, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Pérez-Villa
authors.affiliation: Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Segovia-Cubero
authors.affiliation: Hospital Doce de Octubre, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Delgado-Jiménez
authors.affiliation: Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: González-Vilchez
authors.affiliation: Hospital de Bellvitge, Hospitalet de Llobregat, Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Manito-Lorite
authors.affiliation: Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: De-la-Fuente-Galán
authors.affiliation: Hospital Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Vicens
authors.initials: V
authors.lastname: Brossa-Loidi
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Lambert-Rodríguez
authors.affiliation: Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Pascual-Figal
authors.affiliation: Hospital Virgen del Rocio, Sevilla, Spain.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Lage-Gallé
authors.affiliation: Hospital Reina Sofía, Córdoba, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Arizón-Del-Prado
authors.affiliation: Hospital Miguel Servet, Zaragoza, Spain.
authors.forename: Marisa
authors.initials: M
authors.lastname: Sanz-Julve
authors.affiliation: Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Muñiz-García
authors.affiliation: Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
authors.forename: Marisa
authors.initials: M
authors.lastname: Crespo-Leiro
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual; D004638:Emergency Treatment / Q000009:adverse effects* / Q000401:mortality; D005112:Extracorporeal Circulation / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Extracorporeal; Mechanical circulatory support; Transplantation