Life impact of VA-ECMO due to primary graft dysfunction in patients after orthotopic heart transplantation

René M'Pembele; Sebastian Roth; Alexandra Stroda; Giovanna Lurati Buse; Stephan U. Sixt; Ralf Westenfeld; Amin Polzin; Philipp Rellecke; Igor Tudorache; Markus W. Hollmann; Hug Aubin; Payam Akhyari; Artur Lichtenberg; Ragnar Huhn; Udo Boeken

doi:https://doi.org/10.1002/ehf2.13686

Life impact of VA-ECMO due to primary graft dysfunction in patients after orthotopic heart transplantation

René M'Pembele, Sebastian Roth, Alexandra Stroda, Giovanna Lurati Buse, Stephan U. Sixt, Ralf Westenfeld, Amin Polzin, Philipp Rellecke, Igor Tudorache, Markus W. Hollmann, Hug Aubin, Payam Akhyari, Artur Lichtenberg, Ragnar Huhn, Udo Boeken

Research output: Contribution to journal › Article › Academic › peer-review

7 Citations (Scopus)

Abstract

Aims: Primary graft dysfunction (PGD) is a feared complication after heart transplantation (HTX). HTX patients frequently receive veno-arterial extracorporeal membrane oxygenation (VA-ECMO) until graft recovery. Long-term mortality of patients weaned from VA-ECMO after HTX is comparable with non-ECMO patients. However, impact on quality of life is unknown. This study investigated days alive and out of hospital (DAOH) as patient-centred outcome in HTX patients at 1 year after surgery. Methods and results: This retrospective single-centre cohort study included patients who underwent HTX at the University Hospital Düsseldorf, Germany, from 2010 to 2020. Main exposure was VA-ECMO due to PGD. VA-ECMO and non-VA-ECMO patients were compared regarding the primary endpoint DAOH at 1 year after HTX. Subgroup analysis for patients weaned from VA-ECMO was performed. In total, 144 patients were included into analysis; 1 year mortality was significantly lower in non-ECMO patients [non-ECMO 14.3% (14/98) vs. VA-ECMO 34.8% (16/46), adjusted hazard ratio: 0.32, 95% confidence interval: 0.15–0.74; P = 0.002]. Mortality did not differ significantly between patients weaned from VA-ECMO and non-ECMO patients [non-ECMO 14.3% (14/98) vs. VA-ECMO (weaned) 18.9% (7/37), adjusted hazard ratio: 0.72, 95% confidence interval: 0.27–1.90; P = 0.48]. DAOH were significantly higher in non-ECMO patients compared with VA-ECMO patients and patients weaned from VA-ECMO [non-ECMO vs. VA-ECMO: median 310 (inter-quartile range 277–327) days vs. 243 (0–288) days; P < 0.0001; non-ECMO vs. VA-ECMO (weaned): 310 (277–327) days vs. 253 (208–299) days; P < 0.0001]. These results were still significant after multivariable adjustment with forced entry of predefined covariables. Conclusions: Despite similar survival rates, VA-ECMO due to PGD has a relevant life impact as defined by DAOH in the first year after HTX. As a more patient-centred endpoint, DAOH may contribute to a more comprehensive assessment of outcome in HTX patients.

Original language	English
Pages (from-to)	695-703
Journal	ESC heart failure
Volume	9
Issue number	1
Early online date	2021
DOIs	https://doi.org/10.1002/ehf2.13686
Publication status	Published - 2022

Keywords

Cardiac surgery
Days alive and out of hospital
ECLS
Patient-centred outcomes
Quality of life
VA-ECMO

Access to Document

https://doi.org/10.1002/ehf2.13686

Cite this

M'Pembele, R., Roth, S., Stroda, A., Buse, G. L., Sixt, S. U., Westenfeld, R., Polzin, A., Rellecke, P., Tudorache, I., Hollmann, M. W., Aubin, H., Akhyari, P., Lichtenberg, A., Huhn, R., & Boeken, U. (2022). Life impact of VA-ECMO due to primary graft dysfunction in patients after orthotopic heart transplantation. ESC heart failure, 9(1), 695-703. https://doi.org/10.1002/ehf2.13686

@article{5f0f80ad57884dc18862ef8ea6aa57ff,

title = "Life impact of VA-ECMO due to primary graft dysfunction in patients after orthotopic heart transplantation",

abstract = "Aims: Primary graft dysfunction (PGD) is a feared complication after heart transplantation (HTX). HTX patients frequently receive veno-arterial extracorporeal membrane oxygenation (VA-ECMO) until graft recovery. Long-term mortality of patients weaned from VA-ECMO after HTX is comparable with non-ECMO patients. However, impact on quality of life is unknown. This study investigated days alive and out of hospital (DAOH) as patient-centred outcome in HTX patients at 1 year after surgery. Methods and results: This retrospective single-centre cohort study included patients who underwent HTX at the University Hospital D{\"u}sseldorf, Germany, from 2010 to 2020. Main exposure was VA-ECMO due to PGD. VA-ECMO and non-VA-ECMO patients were compared regarding the primary endpoint DAOH at 1 year after HTX. Subgroup analysis for patients weaned from VA-ECMO was performed. In total, 144 patients were included into analysis; 1 year mortality was significantly lower in non-ECMO patients [non-ECMO 14.3% (14/98) vs. VA-ECMO 34.8% (16/46), adjusted hazard ratio: 0.32, 95% confidence interval: 0.15–0.74; P = 0.002]. Mortality did not differ significantly between patients weaned from VA-ECMO and non-ECMO patients [non-ECMO 14.3% (14/98) vs. VA-ECMO (weaned) 18.9% (7/37), adjusted hazard ratio: 0.72, 95% confidence interval: 0.27–1.90; P = 0.48]. DAOH were significantly higher in non-ECMO patients compared with VA-ECMO patients and patients weaned from VA-ECMO [non-ECMO vs. VA-ECMO: median 310 (inter-quartile range 277–327) days vs. 243 (0–288) days; P < 0.0001; non-ECMO vs. VA-ECMO (weaned): 310 (277–327) days vs. 253 (208–299) days; P < 0.0001]. These results were still significant after multivariable adjustment with forced entry of predefined covariables. Conclusions: Despite similar survival rates, VA-ECMO due to PGD has a relevant life impact as defined by DAOH in the first year after HTX. As a more patient-centred endpoint, DAOH may contribute to a more comprehensive assessment of outcome in HTX patients.",

keywords = "Cardiac surgery, Days alive and out of hospital, ECLS, Patient-centred outcomes, Quality of life, VA-ECMO",

author = "Ren{\'e} M'Pembele and Sebastian Roth and Alexandra Stroda and Buse, {Giovanna Lurati} and Sixt, {Stephan U.} and Ralf Westenfeld and Amin Polzin and Philipp Rellecke and Igor Tudorache and Hollmann, {Markus W.} and Hug Aubin and Payam Akhyari and Artur Lichtenberg and Ragnar Huhn and Udo Boeken",

note = "Publisher Copyright: {\textcopyright} 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.",

year = "2022",

doi = "https://doi.org/10.1002/ehf2.13686",

language = "English",

volume = "9",

pages = "695--703",

journal = "ESC heart failure",

issn = "2055-5822",

publisher = "Wiley",

number = "1",

}

M'Pembele, R, Roth, S, Stroda, A, Buse, GL, Sixt, SU, Westenfeld, R, Polzin, A, Rellecke, P, Tudorache, I, Hollmann, MW, Aubin, H, Akhyari, P, Lichtenberg, A, Huhn, R & Boeken, U 2022, 'Life impact of VA-ECMO due to primary graft dysfunction in patients after orthotopic heart transplantation', ESC heart failure, vol. 9, no. 1, pp. 695-703. https://doi.org/10.1002/ehf2.13686

TY - JOUR

T1 - Life impact of VA-ECMO due to primary graft dysfunction in patients after orthotopic heart transplantation

AU - M'Pembele, René

AU - Roth, Sebastian

AU - Stroda, Alexandra

AU - Buse, Giovanna Lurati

AU - Sixt, Stephan U.

AU - Westenfeld, Ralf

AU - Polzin, Amin

AU - Rellecke, Philipp

AU - Tudorache, Igor

AU - Hollmann, Markus W.

AU - Aubin, Hug

AU - Akhyari, Payam

AU - Lichtenberg, Artur

AU - Huhn, Ragnar

AU - Boeken, Udo

PY - 2022

Y1 - 2022

N2 - Aims: Primary graft dysfunction (PGD) is a feared complication after heart transplantation (HTX). HTX patients frequently receive veno-arterial extracorporeal membrane oxygenation (VA-ECMO) until graft recovery. Long-term mortality of patients weaned from VA-ECMO after HTX is comparable with non-ECMO patients. However, impact on quality of life is unknown. This study investigated days alive and out of hospital (DAOH) as patient-centred outcome in HTX patients at 1 year after surgery. Methods and results: This retrospective single-centre cohort study included patients who underwent HTX at the University Hospital Düsseldorf, Germany, from 2010 to 2020. Main exposure was VA-ECMO due to PGD. VA-ECMO and non-VA-ECMO patients were compared regarding the primary endpoint DAOH at 1 year after HTX. Subgroup analysis for patients weaned from VA-ECMO was performed. In total, 144 patients were included into analysis; 1 year mortality was significantly lower in non-ECMO patients [non-ECMO 14.3% (14/98) vs. VA-ECMO 34.8% (16/46), adjusted hazard ratio: 0.32, 95% confidence interval: 0.15–0.74; P = 0.002]. Mortality did not differ significantly between patients weaned from VA-ECMO and non-ECMO patients [non-ECMO 14.3% (14/98) vs. VA-ECMO (weaned) 18.9% (7/37), adjusted hazard ratio: 0.72, 95% confidence interval: 0.27–1.90; P = 0.48]. DAOH were significantly higher in non-ECMO patients compared with VA-ECMO patients and patients weaned from VA-ECMO [non-ECMO vs. VA-ECMO: median 310 (inter-quartile range 277–327) days vs. 243 (0–288) days; P < 0.0001; non-ECMO vs. VA-ECMO (weaned): 310 (277–327) days vs. 253 (208–299) days; P < 0.0001]. These results were still significant after multivariable adjustment with forced entry of predefined covariables. Conclusions: Despite similar survival rates, VA-ECMO due to PGD has a relevant life impact as defined by DAOH in the first year after HTX. As a more patient-centred endpoint, DAOH may contribute to a more comprehensive assessment of outcome in HTX patients.

AB - Aims: Primary graft dysfunction (PGD) is a feared complication after heart transplantation (HTX). HTX patients frequently receive veno-arterial extracorporeal membrane oxygenation (VA-ECMO) until graft recovery. Long-term mortality of patients weaned from VA-ECMO after HTX is comparable with non-ECMO patients. However, impact on quality of life is unknown. This study investigated days alive and out of hospital (DAOH) as patient-centred outcome in HTX patients at 1 year after surgery. Methods and results: This retrospective single-centre cohort study included patients who underwent HTX at the University Hospital Düsseldorf, Germany, from 2010 to 2020. Main exposure was VA-ECMO due to PGD. VA-ECMO and non-VA-ECMO patients were compared regarding the primary endpoint DAOH at 1 year after HTX. Subgroup analysis for patients weaned from VA-ECMO was performed. In total, 144 patients were included into analysis; 1 year mortality was significantly lower in non-ECMO patients [non-ECMO 14.3% (14/98) vs. VA-ECMO 34.8% (16/46), adjusted hazard ratio: 0.32, 95% confidence interval: 0.15–0.74; P = 0.002]. Mortality did not differ significantly between patients weaned from VA-ECMO and non-ECMO patients [non-ECMO 14.3% (14/98) vs. VA-ECMO (weaned) 18.9% (7/37), adjusted hazard ratio: 0.72, 95% confidence interval: 0.27–1.90; P = 0.48]. DAOH were significantly higher in non-ECMO patients compared with VA-ECMO patients and patients weaned from VA-ECMO [non-ECMO vs. VA-ECMO: median 310 (inter-quartile range 277–327) days vs. 243 (0–288) days; P < 0.0001; non-ECMO vs. VA-ECMO (weaned): 310 (277–327) days vs. 253 (208–299) days; P < 0.0001]. These results were still significant after multivariable adjustment with forced entry of predefined covariables. Conclusions: Despite similar survival rates, VA-ECMO due to PGD has a relevant life impact as defined by DAOH in the first year after HTX. As a more patient-centred endpoint, DAOH may contribute to a more comprehensive assessment of outcome in HTX patients.

KW - Cardiac surgery

KW - Days alive and out of hospital

KW - ECLS

KW - Patient-centred outcomes

KW - Quality of life

KW - VA-ECMO

UR - http://www.scopus.com/inward/record.url?scp=85118497235&partnerID=8YFLogxK

U2 - https://doi.org/10.1002/ehf2.13686

DO - https://doi.org/10.1002/ehf2.13686

M3 - Article

C2 - 34734490

SN - 2055-5822

VL - 9

SP - 695

EP - 703

JO - ESC heart failure

JF - ESC heart failure

IS - 1

ER -

Life impact of VA-ECMO due to primary graft dysfunction in patients after orthotopic heart transplantation

Abstract

Keywords

Access to Document

Other files and links

Cite this