Bridging to orthotopic heart transplant: Reducing the risk of intra-operative blood loss
Background: Orthotopic heart transplantation remains the gold standard for patients with end-stage heart failure. Many devices exist to bridge patients with heart failure to transplant. Impella 5.5 (Abiomed, Danvers MA) is an example of a temporary mechanical assist device, which prioritizes patient...
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Elsevier
2025-05-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425000151 |
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| author | Phoebe Miller, MS MD Andrew Akcelik, MD Alyssa Murillo, MD Alison Baskin, MD Alexander Merriman, PhD Mohammad Arammash, BS Shreyas Kiran, BS Jason Smith, MD Amy G. Fiedler, MD |
| author_facet | Phoebe Miller, MS MD Andrew Akcelik, MD Alyssa Murillo, MD Alison Baskin, MD Alexander Merriman, PhD Mohammad Arammash, BS Shreyas Kiran, BS Jason Smith, MD Amy G. Fiedler, MD |
| author_sort | Phoebe Miller, MS MD |
| collection | DOAJ |
| description | Background: Orthotopic heart transplantation remains the gold standard for patients with end-stage heart failure. Many devices exist to bridge patients with heart failure to transplant. Impella 5.5 (Abiomed, Danvers MA) is an example of a temporary mechanical assist device, which prioritizes patients as Status 2 by the 2018 UNOS policy change, increasing their likelihood of transplantation. Given the increase in device use, we sought to compare intra-operative complications, particularly blood loss, between bridging strategies to transplantation. Methods: We conducted a single-institution retrospective analysis between January 2019 and May 2023. Results: A transfusion requirement was defined as greater than 4 units of blood given intra- or immediately post-operatively (24%, 22/93). The transfusion group was more likely to have had a prior sternotomy (82% vs. 48% p<0.01) and to be on a durable left ventricular assist device (LVAD) (45% vs. 21% p=0.02). There was no difference in anticoagulation or antiplatelet use prior to the odds ratio (OR). The use of Impella 5.5 did not increase the risk of intra-operative bleeding (14% vs. 21% p=0.44). In the adjusted outcomes, factors associated with intra-operative bleeding included average temperature and LVAD (OR 3.63 95% CI [1. −12.3], p=0.04) Conclusion: The shift to prioritize bridging devices has not been met with an increased risk of blood transfusion. We found that parameters such as a prior sternotomy, duration of temporary mechanical assist device (tMCS) use, and the presence of an LVAD were associated. This represents the first study to compare intra- and immediately post-operative transfusion data between bridging devices in the setting of transplantation. |
| format | Article |
| id | doaj-art-d8d90c3be0c047d8989a7f67d70b51db |
| institution | OA Journals |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-d8d90c3be0c047d8989a7f67d70b51db2025-08-20T02:16:12ZengElsevierJHLT Open2950-13342025-05-01810022010.1016/j.jhlto.2025.100220Bridging to orthotopic heart transplant: Reducing the risk of intra-operative blood lossPhoebe Miller, MS MD0Andrew Akcelik, MD1Alyssa Murillo, MD2Alison Baskin, MD3Alexander Merriman, PhD4Mohammad Arammash, BS5Shreyas Kiran, BS6Jason Smith, MD7Amy G. Fiedler, MD8University of California San Francisco, Department of General Surgery, San Francisco, CaliforniaUniversity of California San Francisco, Department of Cardiothoracic Surgery, San Francisco, CaliforniaUniversity of California San Francisco, Department of General Surgery, San Francisco, CaliforniaUniversity of California San Francisco, Department of General Surgery, San Francisco, CaliforniaUniversity of California San Francisco School of Medicine, San Francisco, CaliforniaUniversity of California San Francisco School of Medicine, San Francisco, CaliforniaUniversity of California San Francisco School of Medicine, San Francisco, CaliforniaUniversity of California San Francisco, Department of Cardiothoracic Surgery, San Francisco, CaliforniaUniversity of California San Francisco, Department of Cardiothoracic Surgery, San Francisco, California; Corresponding author: Amy G. Fiedler, MD, Associate Professor of Cardiothoracic Surgery, University of California San Francisco, 513 Parnassus Avenue, HSW 1601, San Francisco, CA 94143-0790.Background: Orthotopic heart transplantation remains the gold standard for patients with end-stage heart failure. Many devices exist to bridge patients with heart failure to transplant. Impella 5.5 (Abiomed, Danvers MA) is an example of a temporary mechanical assist device, which prioritizes patients as Status 2 by the 2018 UNOS policy change, increasing their likelihood of transplantation. Given the increase in device use, we sought to compare intra-operative complications, particularly blood loss, between bridging strategies to transplantation. Methods: We conducted a single-institution retrospective analysis between January 2019 and May 2023. Results: A transfusion requirement was defined as greater than 4 units of blood given intra- or immediately post-operatively (24%, 22/93). The transfusion group was more likely to have had a prior sternotomy (82% vs. 48% p<0.01) and to be on a durable left ventricular assist device (LVAD) (45% vs. 21% p=0.02). There was no difference in anticoagulation or antiplatelet use prior to the odds ratio (OR). The use of Impella 5.5 did not increase the risk of intra-operative bleeding (14% vs. 21% p=0.44). In the adjusted outcomes, factors associated with intra-operative bleeding included average temperature and LVAD (OR 3.63 95% CI [1. −12.3], p=0.04) Conclusion: The shift to prioritize bridging devices has not been met with an increased risk of blood transfusion. We found that parameters such as a prior sternotomy, duration of temporary mechanical assist device (tMCS) use, and the presence of an LVAD were associated. This represents the first study to compare intra- and immediately post-operative transfusion data between bridging devices in the setting of transplantation.http://www.sciencedirect.com/science/article/pii/S2950133425000151heart transplantmechanical support devicebridging to heart transplanttransfusionblood loss |
| spellingShingle | Phoebe Miller, MS MD Andrew Akcelik, MD Alyssa Murillo, MD Alison Baskin, MD Alexander Merriman, PhD Mohammad Arammash, BS Shreyas Kiran, BS Jason Smith, MD Amy G. Fiedler, MD Bridging to orthotopic heart transplant: Reducing the risk of intra-operative blood loss JHLT Open heart transplant mechanical support device bridging to heart transplant transfusion blood loss |
| title | Bridging to orthotopic heart transplant: Reducing the risk of intra-operative blood loss |
| title_full | Bridging to orthotopic heart transplant: Reducing the risk of intra-operative blood loss |
| title_fullStr | Bridging to orthotopic heart transplant: Reducing the risk of intra-operative blood loss |
| title_full_unstemmed | Bridging to orthotopic heart transplant: Reducing the risk of intra-operative blood loss |
| title_short | Bridging to orthotopic heart transplant: Reducing the risk of intra-operative blood loss |
| title_sort | bridging to orthotopic heart transplant reducing the risk of intra operative blood loss |
| topic | heart transplant mechanical support device bridging to heart transplant transfusion blood loss |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425000151 |
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