ABSTRACT
Background
Primary graft dysfunction (PGD) still affects 2-28% of heart transplants (HT). Severe
PGD requires mechanical circulatory support (MCS) and is the main cause of death early
after HT. Earlier initiation has been suggested to improve prognosis but the best
cannulation strategy is unknown.
Methods
Analysis of all HT in Spain between 2010 and 2020. Early (<3 hours after HT) vs late
initiation (≥3 hours after HT) of MCS was compared. Special focus was placed on peripheral
vs central cannulation strategy.
Results
2376 HT were analyzed. 242 (10.2%) suffered severe PGD. 171 (70.7%) received early
MCS and 71 (29.3%) late MCS. Baseline characteristics were similar. Patients with
late MCS had higher inotropic scores and worse renal function at the moment of cannulation.
Early MCS had longer cardiopulmonary bypass times and late MCS was associated with
more peripheral vascular damage. No significant differences in survival were observed
between early and late implant at 3 months (43.82% vs 48.26%; log-rank p=0.59) or
at 1 year (39.29% vs 45.24%, log-rank p=0.49). Multivariate analysis did not show
significant differences favoring early implant. Survival was higher in peripheral
compared to central cannulation at 3 months (52.74% vs. 32.42%, log-rank p 0.001)
and one year (48.56% vs. 28.19%, log-rank p 0.0007). In the multivariate analysis,
peripheral cannulation remained a protective factor.
Conclusions
Earlier MCS initiation for PGD was not superior compared to a more conservative approach
with deferred initiation. Peripheral compared to central cannulation showed superior
3-month and 1-year survival rates.
Keywords
Abbreviations:
PGD (Primary graft dysfunction), HT (Heart Transplant), MCS (Mechanical circulatory support), VA ECMO (Venoarterial extracorporeal membrane oxygenator), VAD (Ventricular assist devices), LVAD (Left ventricular assist device)To read this article in full you will need to make a payment
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