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Utilization and Outcomes of Temporary Mechanical Circulatory Support for Graft Dysfunction After Heart Transplantation

Phan, Kevin*†; Luc, Jessica G. Y.; Xu, Joshua*; Maltais, Simon§; Stulak, John M.§; Yan, Tristan D.†¶; Tchantchaleishvili, Vakhtang†‖#

doi: 10.1097/MAT.0000000000000599
Review Article

Graft dysfunction is the main cause of early mortality after heart transplantation. In cases of severe graft dysfunction, temporary mechanical circulatory support (TMCS) may be necessary. The aim of this systematic review was to examine the utilization and outcomes of TMCS in patients with graft dysfunction after heart transplantation. Electronic search was performed to identify all studies in the English literature assessing the use of TMCS for graft dysfunction. All identified articles were systematically assessed for inclusion and exclusion criteria. Of the 5,462 studies identified, 41 studies were included. Among the 11,555 patients undergoing heart transplantation, 695 (6.0%) required TMCS with patients most often supported using venoarterial extracorporeal membrane oxygenation (79.4%) followed by right ventricular assist devices (11.1%), biventricular assist devices (BiVADs) (7.5%), and left ventricular assist devices (LVADs) (2.0%). Patients supported by LVADs were more likely to be supported longer (p = 0.003), have a higher death by cardiac event (p = 0.013) and retransplantation rate (p = 0.015). In contrast, patients supported with BiVAD and LVAD were more likely to be weaned off support (p = 0.020). Overall, no significant difference was found in pooled 30 day survival (p = 0.31), survival to discharge (p = 0.19), and overall survival (p = 0.51) between the subgroups. Temporary mechanical circulatory support is an effective modality to support patients with graft dysfunction after heart transplantation. Further studies are needed to establish the optimal threshold and strategy for TMCS and to augment cardiac recovery and long-term survival.

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From the *Faculty of Medicine, University of Sydney, Sydney, Australia; The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; Faculty of Medicine and Dentistry, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; §Department of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia; Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York; and #Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.

Submitted for consideration August 2016; accepted for publication in revised form April 2017.

Disclosure: The authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Vakhtang Tchantchaleishvili, Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Box Cardiac Surgery, 601 Elmwood Avenue, Rochester, NY 14642. Email: vakhtang_tchantchaleishvili@urmc.rochester.edu.

Copyright © 2017 by the American Society for Artificial Internal Organs