17 research outputs found
Lessons learned from extracorporeal membrane oxygenation as a bridge to lung transplantation
Extracorporeal membrane oxygenation (ECMO) has been used infrequently as a bridge to lung transplantation due to lack of consensus and data regarding the benefits of such a strategy. We present data from the United Network of Organ Sharing (UNOS) database on the outcomes of patients bridged to lung transplantation with ECMO. We used the UNOS database to analyze data between January 1, 2000 and December 31, 2011. During this time 14,263 lung transplants were performed, of which 143 (1.0%) were bridged using ECMO. Patients on ECMO as a bridge to lung transplantation were compared to those transplanted without prior ECMO support. Demographics, survival rates, complications, and rejection episodes were compared between the two groups. The 30-day, 6-month, 1-year, 3-year, and 5-year survival rates were 69%, 56%, 48%, 26%, and 11%, respectively, for the ECMO bridge group and 95%, 88%, 81%, 58%, and 38% respectively, for the control group (p ≤ 0.01). The ECMO group incurred higher rate of postoperative complications, including airway dehiscence (4% vs. 1%, p ≤ 0.01), stroke (3% vs. 2%, p ≤ 0.01), infection (56% vs. 42%, p ≤ 0.01), and pulmonary embolism (10% vs. 0.6%, p ≤ 0.01). The length of hospital stay was longer for the ECMO group (41 vs. 25 days, p ≤ 0.01), and they were treated for rejection more often (49% vs. 36%, p = 0.02). The use of ECMO as a bridge to lung transplantation is associated with significantly worse survival and more frequent postoperative complications. Therefore, we advocate very careful patient selection and cautious use of ECMO
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Heart Transplantation Survival and the Use of Traumatically Brain-Injured Donors: UNOS Registry Propensity-Matched Analysis
Background-The transplantation of hearts from traumatically brain-injured (TBI) donors has been associated with inferior long-term survival in single-center analyses. However, in a more recent analysis, death caused by cerebrovascular accident was associated with worse posttransplant survival in recipients. The purpose of this study was to explore the outcomes of heart transplantation in recipients receiving donor hearts from TBI and non-TBI donors in a large national registry. Methods and Results-We performed a retrospective cohort analysis of the UNOS (United Network of Organ Sharing) Registry Organ Procurement and Transplantation Network between 2006 and 2018 for adult candidates wait-listed for isolated heart transplantation. Recipients were stratified into 2 groups, TBI and non-TBI donors. Propensity score matching was performed. Kaplan-Meier analysis was used to estimate survival posttransplant. A total of 24 894 candidates met inclusion criteria. TBI was the leading cause of death in the donor population. Recipients of TBI donor hearts (N=13 07) were younger (median age, 55 versus 57 years; P<0.001) and less likely women (21.6% versus 29.8%; P<0.001). At 10 years, the TBI group had better long-term survival compared with the non-TBI group (62.8% versus 59.9%; P<0.001). After propensity group matching, the 10-year survival was similar between groups. Conclusions-In the largest analysis of heart transplants and their survival, according to the type of donor injury (TBI versus non-TBI), we found similar survival in heart transplant recipients. Future studies should address specific subpopulations (eg, hemorrhagic stroke) in the non-TBI group to address concerns about reduced posttransplant survival.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]
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Aortic Prosthetic Valve Endocarditis: Analysis of The Society of Thoracic Surgeons Database
Background: This study sought to characterize the current US experience of aortic prosthetic valve endocarditis (PVE) compared with native valve endocarditis (NVE). Methods: The Society of Thoracic Surgeons Database was queried for entries of active aortic infective endocarditis (IE). Two analyses were performed: (1) trends of surgical volume and operative mortality (2011-2019); and (2) descriptive and risk-adjusted comparisons between PVE and NVE (2014-2019) using multivariable logistic regression. Results: From 2011 to 2019, there was a yearly increase in the proportion of PVE (20.9% to 25.9%; P <.001) with a concurrent decrease in operative mortality (PVE, 22.5% to 10.4%; P <.001; NVE, 10.9% to 8.5%; P <.001). From 2014 to 2019, active aortic IE was identified in 9768 patients (NVE, 6842; PVE, 2926). Aortic root abscess (50.1% vs 25.2%; P <.001), aortic root replacement (50.1% vs 12.8%; P <.001), homograft implantation (27.2% vs 4.1%; P <.001), and operative mortality (12.2% vs 6.4%; P <.001) were higher in PVE. After risk adjustment, PVE (odds ratio [OR], 1.5; 95% CI,1.16-1.94; P <.01), aortic root replacement (OR, 1.49; 95% CI,1.15-1.92; P <.001), Staphylococcus aureus (OR, 1.5; 95% CI,1.23-1.82; P <.001), and unplanned revascularization (OR, 5.83; 95% CI,4.12-8.23; P <.001) or mitral valve surgery (OR, 2.29; 95% CI,1.5-3.51; P <.001) correlated with a higher operative mortality, whereas prosthesis type (P =.68) was not an independent predictor. Conclusions: IE in the United States has risen over the past decade. However, operative mortality has decreased for both PVE and NVE. PVE, extension of IE requiring aortic root replacement, and additional unplanned surgical interventions carry an elevated mortality risk. Prosthesis selection did not affect operative mortality.12 month embargo; published: 04 December 2021This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]