https://doi.org/10.1177/0391398820903312
The International Journal of Artificial
Organs
1–8
© The Author(s) 2020
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DOI: 10.1177/0391398820903312
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e International
Journal of Artificial
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Introduction
Even though intra-aortic balloon pump (IABP) has been
used for over five decades as bridge-to-transplant (BTT)
in patients with refractory cardiogenic shock (CS), its role
has been debated in the past few years with the availability
of newer devices which provide better hemodynamic sup-
port.
1,2
There have been multiple small single-center stud-
ies reporting the use of IABP as bridge to transplantation
Waitlist and post-transplant outcomes
in patients listed with intra-aortic
balloon pump for heart transplant: United
Network for Organ Sharing registry
Antonio Duran
1
, Duc T Nguyen
2,3
, Edward A Graviss
2,3
,
Arvind Bhimaraj
2,4
, Barry Trachtenberg
2,4
, Imad Hussain
2,4
,
Muyng Park
2,4
, Jerry D Estep
5
, Eric E Suarez
2,4
and Ashrith Guha
2,4
Abstract
Background: Intra-aortic balloon pump as bridge-to-transplant (BTT) has been used successfully in patients with
refractory cardiogenic shock. However, the waitlist mortality in this population is high and predictors of waitlist mortality
in this population are not known. We sought to identify predictors for waitlist mortality in patients listed with intra-
aortic balloon pump and risk factors for 1-year mortality after heart transplant in this population.
Methods: We identified patients listed for heart transplantation with intra-aortic balloon pump in the United Network
for Organ Sharing data set from 1994 to 2015. Univariable and multivariable Cox proportional hazards models were
used to identify predictors of waitlist mortality and 1-year post-transplant mortality.
Results: From 1945 patients listed with intra-aortic balloon pump, 67.5% (N = 1313) were alive at 1 year and waitlist
mortality was 32.5% (N = 632). We found that higher pulmonary vascular resistance, need for inotropes, and need
for mechanical ventilation were associated with higher waitlist mortality. Mechanical ventilation and dialysis prior to
transplantation were important predictors of 1-year post-transplant mortality.
Conclusion: Predictors of mortality such as high pulmonary vascular resistance, dialysis dependence, inotrope, and
ventilator dependence in patients listed with intra-aortic balloon pump can help us identify those patients that are at high
risk of dying prior to a heart transplantation.
Keywords
Intra-aortic balloon pump, predictors, waitlist mortality, United Network for Organ Sharing
Date received: 22 September 2019; accepted: 9 January 2020
1
Department of Internal Medicine, Houston Methodist Hospital,
Houston, TX, USA
2
Houston Methodist DeBakey Heart & Vascular Center, Houston
Methodist Hospital, Houston, TX, USA
3
Houston Methodist Research Institute, Houston Methodist Hospital,
Houston, TX, USA
4
J.C. Walter Jr. Transplant Center, Houston Methodist Hospital,
Houston, TX, USA
903312JAO 0 0 10.1177/0391398820903312The International Journal of Artificial OrgansDuran et al.
research-article 2020
Original research article
5
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland,
OH, USA
Corresponding author:
Ashrith Guha, Department of Cardiology, Houston Methodist DeBakey
Heart & Vascular Center, Houston Methodist Hospital, 6550 Fannin
St., Suite 1901, Houston, TX 77030, USA.
Email: gashrith@houstonmethodist.org