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      Implication of Ventricular Assist Devices in Extracorporeal Membranous Oxygenation Patients Listed for Heart Transplantation

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          Abstract

          The new allocation criteria classify patients on veno-arterial extracorporeal membranous oxygenation (VA-ECMO) as the highest priority for receiving orthotopic heart transplantation (OHT) especially if they are considered not candidates for ventricular assist devices. The outcomes of patients who receive ventricular assist devices (VADs) after being listed for heart transplantation with VA-ECMO is unknown. We analyzed 355 patients listed for OHT with VA-ECMO from the United Network for Organ Sharing database from 2006 to 2014. Univariate and multivariate Cox proportional-hazards models were used to determine the contribution of prognostic variables to the outcome. Thirty-three patients (9.3%) received VADs (15 dischargeable, 7 non-dischargeable VADs). The VAD and non-VAD groups had similar listing characteristics except that the VAD group were more likely to have non-ischemic cardiomyopathy (48.5% vs. 25.2%), and less likely to be obese (6.1% vs. 25.2%) or have a history of prior organ transplant (3% vs. 31.1%). Patients who underwent VAD implantation had more days on the list (median 189 vs. 14 days) compared to the non-VAD group. Amongst the patients who had VADs, (25/33) 75.5% patients were subsequently transplanted with similar post-transplant survival compared to the non-VAD group (72% vs. 60.5%; p = 0.276). Predictors of one-year post-transplant mortality included panel reactive antibodies (PRA) class I ≥ 20%, recipient smoking history, increased serum creatinine and total bilirubin. Therefore, a small proportion of patients listed for transplantation with VA ECMO undergo VAD implantation. Their waitlist survival is better than non-VAD group but with similar post-transplant survival.

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          Seventh INTERMACS annual report: 15,000 patients and counting.

          The seventh annual report of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) summarizes the first 9 years of patient enrollment. The Registry includes >15,000 patients from 158 participating hospitals. Trends in device strategy, patient profile at implant and survival are presented. Risk factors for mortality with continuous-flow pumps are updated, and the major causes/modes of death are presented. The adverse event burden is compared between eras, and health-related quality of life is reviewed. A detailed analysis of outcomes after mechanical circulatory support for ambulatory heart failure is presented. Recent summary data from PediMACS and MedaMACS is included. With the current continuous-flow devices, survival at 1 and 2 years is 80% and 70%, respectively.
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            Extra Corporeal Membrane Oxygenation (ECMO) review of a lifesaving technology.

            Extra Corporeal Membrane Oxygenation (ECMO) indications and usage has strikingly progressed over the last 20 years; it has become essential tool in the care of adults and children with severe cardiac and pulmonary dysfunction refractory to conventional management. In this article we will provide a review of ECMO development, clinical indications, patients' management, options and cannulations techniques, complications, outcomes, and the appropriate strategy of organ management while on ECMO.
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              The registry of the International Society for Heart and Lung Transplantation: thirty-first official adult heart transplant report--2014; focus theme: retransplantation.

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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                26 April 2019
                May 2019
                : 8
                : 5
                : 572
                Affiliations
                [1 ]Department of Cardiology, Houston Methodist J.C. Walter Transplant Center, Houston Methodist Hospital, 6550 Fannin St., Houston, TX 77030, USA; babruckner@ 123456houstonmethodist.org (B.A.B.); btrachtenberg@ 123456houstonmethodist.org (B.T.); abhimaraj@ 123456houstonmethodist.org (A.B.); parkmh0519@ 123456gmail.com (M.P.); ihussain@ 123456houstonmethodist.org (I.H.); eesuarez@ 123456houstonmethodist.org (E.E.S.)
                [2 ]Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Houston, TX 77030, USA; basharhannawi@ 123456gmail.com (B.H.); sofiacruzs@ 123456gmail.com (A.S.C.-S.); tmacgillivray@ 123456houstonmethodist.org (T.E.M.)
                [3 ]Houston Methodist Research Institute, Department of Pathology and Genomic Medicine, 6670 Bertner Ave, Houston, TX 77030, USA; dtnguyen6@ 123456houstonmethodist.org (D.T.N.); eagraviss@ 123456houstonmethodist.org (E.A.G.)
                [4 ]Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; estepj@ 123456ccf.org
                [5 ]Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
                Author notes
                [* ]Correspondence: gashrith@ 123456houstonmethodist.org ; Tel.: +1-713-441-1100; Fax: +1-713-790-2643
                [†]

                These authors contributed equally to this work.

                Article
                jcm-08-00572
                10.3390/jcm8050572
                6572206
                31035470
                7eff7b4b-db66-4118-b2fb-d19aac16ccd7
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 02 April 2019
                : 23 April 2019
                Categories
                Article

                ventricular assist devices,heart transplant,veno-arterial extracorporeal membranous oxygenation,organ allocation

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