Percutaneous Temporary Mechanical Circulatory Support as a Bridge to Heart Transplantation in the Current UNOS Allocation System

作者：Rohan Goswami, Jose Ruiz, Aarti Desai, Peter Wlodkowski, Başar Sareyyüpoğlu, Sean Kiley, Anirban Bhattacharyya, Daniel Yip, Melissa Lyle, José Nativi-Nicolau, Juan Leoni, Devang Sanghavi, Alfredo Quiñones‐Hinojosa, Sanjay Chaudhary, Kevin Landolfo, Si M. Pham, Parag C. Patel · 发表于：Biomedicines · 年份：2025 · DOI：10.3390/biomedicines13112637 · 被引用次数：1 · 研究领域：Mechanical Circulatory Support Devices、Cardiac and Coronary Surgery Techniques、Cardiac Structural Anomalies and Repair

Background: Progressive heart failure cardiogenic shock (HFCS) often requires escalation to temporary or durable mechanical circulatory support (MCS) as a bridge to transplant (BTT). Following the 2018 UNOS allocation changes, our center revised its BTT strategy to optimize support and shorten wait times. At our institution, the Impella 5.5 with SmartAssist via the axillary approach was selectively used for patients who remained refractory to guideline-directed medical therapy, failed single-inotrope therapy, and were not considered suitable durable LVAD candidates by our multidisciplinary heart team. We compared transplant-related outcomes of BTT patients supported with Impella 5.5 versus durable LVAD. Methods: We performed a single-center retrospective review of all heart and heart/kidney transplant candidates at Mayo Clinic Florida from October 2018 to February 2021. INTERMACS profile, baseline characteristics, and perioperative data were collected at the time of device implantation and throughout the transplant hospitalization. Results: A total of 87 heart and 4 heart–kidney transplants were completed. Forty-five patients (49%) required MCS as BTT: 27 (60%) with a durable LVAD and 18 (40%) with an Impella 5.5. All eighteen patients with Impella 5.5 as BTT (100%) were transplanted compared to nineteen patients with durable LVAD (70%), p = 0.001. The median time from listing to transplant was substantially shorter with Impella (32 vs. 696 days, p < 0.001), and this diffe...