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Bridge to transplantation from mechanical circulatory support: a narrative review

OBJECTIVE: To highlight recent developments in the utilization of mechanical circulatory support (MCS) devices as bridge-to-transplant strategies and to discuss trends in MCS use following the changes to the United Network for Organ Sharing (UNOS) heart allocation system. BACKGROUND: MCS devices hav...

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Autores principales: Zhou, Alice L., Etchill, Eric W., Giuliano, Katherine A., Shou, Benjamin L., Sharma, Kavita, Choi, Chun W., Kilic, Ahmet
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743412/
https://www.ncbi.nlm.nih.gov/pubmed/35070375
http://dx.doi.org/10.21037/jtd-21-832
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author Zhou, Alice L.
Etchill, Eric W.
Giuliano, Katherine A.
Shou, Benjamin L.
Sharma, Kavita
Choi, Chun W.
Kilic, Ahmet
author_facet Zhou, Alice L.
Etchill, Eric W.
Giuliano, Katherine A.
Shou, Benjamin L.
Sharma, Kavita
Choi, Chun W.
Kilic, Ahmet
author_sort Zhou, Alice L.
collection PubMed
description OBJECTIVE: To highlight recent developments in the utilization of mechanical circulatory support (MCS) devices as bridge-to-transplant strategies and to discuss trends in MCS use following the changes to the United Network for Organ Sharing (UNOS) heart allocation system. BACKGROUND: MCS devices have played an increasingly important role in the treatment of heart failure patients. Over the past several years, technological advancements have led to new developments in MCS devices and expanding indications for MCS use. In October of 2018, the UNOS heart allocation policy was revised to prioritize higher-urgency patients, including those supported with temporary MCS devices. Since then, changes in trends of MCS utilization have been observed. METHODS: Articles from the PubMed database regarding the use of MCS devices as bridge-to-transplant strategies were reviewed. CONCLUSIONS: Over the past decade, utilization of temporary MCS devices, which include the intra-aortic balloon pump (IABP), percutaneous ventricular assist devices (pVADs), and extracorporeal membrane oxygenation (ECMO), has become increasingly common. Recent advancements in MCS include the development of pVADs that can fully unload the left ventricle (LV) as well as devices designed to provide right-sided support. Technological advancements in durable left ventricular assist devices (LVADs) have also led to improved outcomes both on the device and following heart transplantation. Following the 2018 UNOS heart allocation policy revision, the utilization of temporary MCS in advanced heart failure patients has further increased and the proportion of patients bridged directly from a temporary MCS device has exponentially risen. However, following the start of the COVID-19 pandemic, the trends have reversed, with a decrease in the percentage of patients bridged from a temporary MCS device. As long-term data following the allocation policy revision becomes available, future studies should investigate how trends in MCS use for patients with advanced heart failure continue to evolve.
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spelling pubmed-87434122022-01-21 Bridge to transplantation from mechanical circulatory support: a narrative review Zhou, Alice L. Etchill, Eric W. Giuliano, Katherine A. Shou, Benjamin L. Sharma, Kavita Choi, Chun W. Kilic, Ahmet J Thorac Dis Review Article OBJECTIVE: To highlight recent developments in the utilization of mechanical circulatory support (MCS) devices as bridge-to-transplant strategies and to discuss trends in MCS use following the changes to the United Network for Organ Sharing (UNOS) heart allocation system. BACKGROUND: MCS devices have played an increasingly important role in the treatment of heart failure patients. Over the past several years, technological advancements have led to new developments in MCS devices and expanding indications for MCS use. In October of 2018, the UNOS heart allocation policy was revised to prioritize higher-urgency patients, including those supported with temporary MCS devices. Since then, changes in trends of MCS utilization have been observed. METHODS: Articles from the PubMed database regarding the use of MCS devices as bridge-to-transplant strategies were reviewed. CONCLUSIONS: Over the past decade, utilization of temporary MCS devices, which include the intra-aortic balloon pump (IABP), percutaneous ventricular assist devices (pVADs), and extracorporeal membrane oxygenation (ECMO), has become increasingly common. Recent advancements in MCS include the development of pVADs that can fully unload the left ventricle (LV) as well as devices designed to provide right-sided support. Technological advancements in durable left ventricular assist devices (LVADs) have also led to improved outcomes both on the device and following heart transplantation. Following the 2018 UNOS heart allocation policy revision, the utilization of temporary MCS in advanced heart failure patients has further increased and the proportion of patients bridged directly from a temporary MCS device has exponentially risen. However, following the start of the COVID-19 pandemic, the trends have reversed, with a decrease in the percentage of patients bridged from a temporary MCS device. As long-term data following the allocation policy revision becomes available, future studies should investigate how trends in MCS use for patients with advanced heart failure continue to evolve. AME Publishing Company 2021-12 /pmc/articles/PMC8743412/ /pubmed/35070375 http://dx.doi.org/10.21037/jtd-21-832 Text en 2021 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Review Article
Zhou, Alice L.
Etchill, Eric W.
Giuliano, Katherine A.
Shou, Benjamin L.
Sharma, Kavita
Choi, Chun W.
Kilic, Ahmet
Bridge to transplantation from mechanical circulatory support: a narrative review
title Bridge to transplantation from mechanical circulatory support: a narrative review
title_full Bridge to transplantation from mechanical circulatory support: a narrative review
title_fullStr Bridge to transplantation from mechanical circulatory support: a narrative review
title_full_unstemmed Bridge to transplantation from mechanical circulatory support: a narrative review
title_short Bridge to transplantation from mechanical circulatory support: a narrative review
title_sort bridge to transplantation from mechanical circulatory support: a narrative review
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743412/
https://www.ncbi.nlm.nih.gov/pubmed/35070375
http://dx.doi.org/10.21037/jtd-21-832
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