Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Impact of a Multidisciplinary Team Approach on Extracorporeal Circulatory Life Support-Bridged Heart Transplantation

  • Lee, Jae Jun (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Young Su (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chung, Suryeun (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeong, Dong Seop (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yang, Ji-Hyuk (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sung, Kiick (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Wook Sung (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jun, Tae-Gook (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cho, Yang Hyun (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2020.09.16
  • Accepted : 2020.11.11
  • Published : 2021.04.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The number of heart transplantations (HTx) is increasing annually. Due to advances in medical and surgical support, the outcomes of HTx are also improving. Extracorporeal circulatory life support (ECLS) provides patients with decompensated heart failure a chance to undergo HTx. A medical approach involving collaboration among experienced experts in different fields should improve the outcomes and prognosis of ECLS-bridged HTx. Methods: From December 2003 to December 2018, 1,465 patients received ECLS at Samsung Medical Center. We excluded patients who had not undergone HTx or underwent repeated transplantations. Patients younger than 18 years were excluded. We also excluded patients who received an implantable durable left ventricular assist device before HTx. In total, 91 patients were included in this study. A multidisciplinary team approach began in March 2013 at our hospital. We divided the patients into 2 groups depending on whether they were treated before or after implementation of the team approach. Results: The 30-day mortality rate was significantly higher in the pre-ECLS team group than in the post-ECLS team group (n=5, 18.5% vs. n=2, 3.1%; p=0.023). The 1-year survival rate was better in the post-ECLS team group than in the pre-ECLS team group (n=57, 89.1% vs. n=19, 70.4%; p=0.023). Conclusion: We found that implementing a multidisciplinary team approach improved the outcomes of ECLS-bridged HTx. Team-based care should be adapted at HTx centers that perform high-risk HTx.

Keywords

References

  1. Lee HY, Jeon ES, Kang SM, Kim JJ. Initial report of the Korean Organ Transplant Registry (KOTRY): heart transplantation. Korean Circ J 2017;47:868-76. https://doi.org/10.4070/kcj.2016.0403
  2. Kim IC, Youn JC, Kobashigawa JA. The past, present and future of heart transplantation. Korean Circ J 2018;48:565-90. https://doi.org/10.4070/kcj.2018.0189
  3. Kim D, Choi JO, Oh J, et al. The Korean Organ Transplant Registry (KOTRY): second official adult heart transplant report. Korean Circ J 2019;49:724-37. https://doi.org/10.4070/kcj.2018.0392
  4. Youn JC, Han S, Ryu KH. Temporal trends of hospitalized patients with heart failure in Korea. Korean Circ J 2017;47:16-24. https://doi.org/10.4070/kcj.2016.0429
  5. Youn JC, Kim IC, Park NH, Kim H. Increased risk with older donor age and more frequent pre-transplant ECMO: the second official KOTRY report. Korean Circ J 2019;49:738-41. https://doi.org/10.4070/kcj.2019.0117
  6. Fukuhara S, Takeda K, Kurlansky PA, Naka Y, Takayama H. Extracorporeal membrane oxygenation as a direct bridge to heart transplantation in adults. J Thorac Cardiovasc Surg 2018;155:1607-18. https://doi.org/10.1016/j.jtcvs.2017.10.152
  7. Hong D, Choi KH, Cho YH, et al. Multidisciplinary team approach in acute myocardial infarction patients undergoing veno-arterial extracorporeal membrane oxygenation. Ann Intensive Care 2020;10:83. https://doi.org/10.1186/s13613-020-00701-8
  8. Na SJ, Chung CR, Choi HJ, et al. The effect of multidisciplinary extracorporeal membrane oxygenation team on clinical outcomes in patients with severe acute respiratory failure. Ann Intensive Care 2018;8:31. https://doi.org/10.1186/s13613-018-0375-9
  9. Reyentovich A, Barghash MH, Hochman JS. Management of refractory cardiogenic shock. Nat Rev Cardiol 2016;13:481-92. https://doi.org/10.1038/nrcardio.2016.96
  10. Millar JE, Fanning JP, McDonald CI, McAuley DF, Fraser JF. The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology. Crit Care 2016;20:387. https://doi.org/10.1186/s13054-016-1570-4
  11. Biffi S, Di Bella S, Scaravilli V, et al. Infections during extracorporeal membrane oxygenation: epidemiology, risk factors, pathogenesis and prevention. Int J Antimicrob Agents 2017;50:9-16. https://doi.org/10.1016/j.ijantimicag.2017.02.025
  12. Xie A, Lo P, Yan TD, Forrest P. Neurologic complications of extracorporeal membrane oxygenation: a review. J Cardiothorac Vasc Anesth 2017;31:1836-46. https://doi.org/10.1053/j.jvca.2017.03.001
  13. Ouweneel DM, Schotborgh JV, Limpens J, et al. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med 2016;42:1922-34. https://doi.org/10.1007/s00134-016-4536-8
  14. Dalia AA, Ortoleva J, Fiedler A, Villavicencio M, Shelton K, Cudemus GD. Extracorporeal membrane oxygenation is a team sport: institutional survival benefits of a formalized ECMO team. J Cardiothorac Vasc Anesth 2019;33:902-7. https://doi.org/10.1053/j.jvca.2018.06.003
  15. Komindr A, Abe R, Tateishi Y, et al. Establishing extracorporeal membrane oxygenation team increased number of patients and improved data recording. J Intensive Care 2019;7:11. https://doi.org/10.1186/s40560-019-0366-4
  16. Foroutan F, Alba AC, Guyatt G, et al. Predictors of 1-year mortality in heart transplant recipients: a systematic review and meta-analysis. Heart 2018;104:151-60. https://doi.org/10.1136/heartjnl-2017-311435
  17. Chokshi A, Cheema FH, Schaefle KJ, et al. Hepatic dysfunction and survival after orthotopic heart transplantation: application of the MELD scoring system for outcome prediction. J Heart Lung Transplant 2012;31:591-600. https://doi.org/10.1016/j.healun.2012.02.008