Microaxial mechanical circulatory support after orthotopic heart transplantation

• Published in: International journal of artificial organs 2024-03, Vol.47 (3), p.173-180
• Main Authors: Pritting, Christopher, Ahmad, Danial, Patel, Keyur, Miyamoto, Takuma, Rajab, Taufiek K, Rajapreyar, Indranee N, Massey, Howard T, Tchantchaleishvili, Vakhtang
• Format: Article
• Language: English
• Subjects: Adolescents; Adults; Graft rejection; Grafting; Heart diseases; Heart transplantation; Heart transplants; Rejection; Statistical analysis; Survival; Teenagers; Transplantation
• ISSN: 0391-3988; 1724-6040; 1724-6040
• DOI: 10.1177/03913988231213722

Aim: Use of microaxial mechanical circulatory support (MCS) has been reported for severe graft rejection or dysfunction after heart transplantation (HTx). We aimed to assess utilization patterns of microaxial MCS after HTx in adolescents (ages 18 and younger) and adults (ages 19 and older). Methods: Electronic search was performed to identify all relevant studies on post-HTx use of microaxial support in adults and adolescents. A total of 18 studies were selected and patient-level data were extracted for statistical analysis. Results: All patients (n=23), including adults (n=15) and adolescents (n=8), underwent Impella (Abiomed, Danvers, MA) microaxial MCS after HTx. Median age was 36 [IQR 18–56] years (Adults, 52 [37–59]; adolescents, 16 [15–17]). Primary right ventricular graft dysfunction was an indication exclusively seen in the adults 40% (6/15), while acute graft rejection was present in 46.7% (7/15) of adults. Median time after transplant was 9 [0–32] months (Adults, 4 [0–32]; adolescents, 11 [4.5, 45]). Duration of Impella support was comparable between adults and adolescents (5 [2.5–8] vs 6 [5–8] days, p = 0.38). Overall improvement was observed both in median LV ejection fraction (23.5% [11.3–28] to 42% [37.8–47.3], p