Peripheral versus central cannulation of VA-ECMO for primary graft dysfunction after heart transplantation: A systematic review and meta-analysis
Background: Severe primary graft dysfunction (PGD) after heart transplantation (HT) is a major cause of death and requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods: We conducted a systematic review and meta-analysis including studies of adult HT recipients who required VA...
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Elsevier
2025-02-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S295013342400123X |
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| author | Eduard Ródenas-Alesina, MD Aleix Olivella, MD Ani Orchanian-Cheff, MiST Farid Foroutan, PhD Yasbanoo Moayedi, MD, MSc Vivek Rao, MD, PhD Filio Billia, MD, PhD Heather J. Ross, MD, MHSc Ana Carolina Alba, MD, PhD Natasha Aleksova, MD, MSc |
| author_facet | Eduard Ródenas-Alesina, MD Aleix Olivella, MD Ani Orchanian-Cheff, MiST Farid Foroutan, PhD Yasbanoo Moayedi, MD, MSc Vivek Rao, MD, PhD Filio Billia, MD, PhD Heather J. Ross, MD, MHSc Ana Carolina Alba, MD, PhD Natasha Aleksova, MD, MSc |
| author_sort | Eduard Ródenas-Alesina, MD |
| collection | DOAJ |
| description | Background: Severe primary graft dysfunction (PGD) after heart transplantation (HT) is a major cause of death and requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods: We conducted a systematic review and meta-analysis including studies of adult HT recipients who required VA-ECMO for PGD to determine whether a peripheral or central configuration was associated with higher mortality. The primary endpoints were short-term and one-year mortality. Secondary endpoints were VA-ECMO-related complications. Results: Overall, we included 16 studies comprising 874 patients from 33 centers. Using a random-effects model, peripheral cannulation was associated with a nonsignificant reduction in short-term mortality (odds ratios [OR] = 0.73, 95% confidence interval [CI] = 0.41-1.28, I2 = 55.8%) and a significant reduction in 1-year mortality (OR = 0.60, 95%CI = 0.37-0.97, I2 = 35.9%). Peripheral cannulation decreased the risk of bleeding but increased the risk of limb ischemia and infection, with similar rates of stroke and need for renal replacement therapy. Overall, certainty of evidence was low. Conclusions: With low certainty evidence, peripheral VA-ECMO cannulation may reduce short-term and 1-year mortality with lower bleeding rates but higher limb-related complications, supporting peripheral configuration in HT recipients with severe PGD. |
| format | Article |
| id | doaj-art-abb52144cbe4467980d4bf5ebdbc6c2f |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-abb52144cbe4467980d4bf5ebdbc6c2f2025-02-09T05:01:55ZengElsevierJHLT Open2950-13342025-02-017100174Peripheral versus central cannulation of VA-ECMO for primary graft dysfunction after heart transplantation: A systematic review and meta-analysisEduard Ródenas-Alesina, MD0Aleix Olivella, MD1Ani Orchanian-Cheff, MiST2Farid Foroutan, PhD3Yasbanoo Moayedi, MD, MSc4Vivek Rao, MD, PhD5Filio Billia, MD, PhD6Heather J. Ross, MD, MHSc7Ana Carolina Alba, MD, PhD8Natasha Aleksova, MD, MSc9Cardiology Department, Hospital Universitari Vall d′Hebron, Vall d′Hebron Institut de Recerca, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, SpainCardiology Department, Hospital Universitari Vall d′Hebron, Vall d′Hebron Institut de Recerca, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, SpainLibrary and Information Services, University Health Network, Toronto, Ontario, CanadaPeter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, CanadaPeter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, CanadaPeter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, CanadaPeter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, CanadaPeter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, CanadaPeter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, CanadaPeter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Women’s College Hospital, Toronto, Ontario, Canada; Corresponding author: Natasha Aleksova, MD, MSc, Peter Munk Cardiac Centre, 4NU 484, Toronto General Hospital, Toronto, Ontario M5G 2N2, Canada.Background: Severe primary graft dysfunction (PGD) after heart transplantation (HT) is a major cause of death and requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods: We conducted a systematic review and meta-analysis including studies of adult HT recipients who required VA-ECMO for PGD to determine whether a peripheral or central configuration was associated with higher mortality. The primary endpoints were short-term and one-year mortality. Secondary endpoints were VA-ECMO-related complications. Results: Overall, we included 16 studies comprising 874 patients from 33 centers. Using a random-effects model, peripheral cannulation was associated with a nonsignificant reduction in short-term mortality (odds ratios [OR] = 0.73, 95% confidence interval [CI] = 0.41-1.28, I2 = 55.8%) and a significant reduction in 1-year mortality (OR = 0.60, 95%CI = 0.37-0.97, I2 = 35.9%). Peripheral cannulation decreased the risk of bleeding but increased the risk of limb ischemia and infection, with similar rates of stroke and need for renal replacement therapy. Overall, certainty of evidence was low. Conclusions: With low certainty evidence, peripheral VA-ECMO cannulation may reduce short-term and 1-year mortality with lower bleeding rates but higher limb-related complications, supporting peripheral configuration in HT recipients with severe PGD.http://www.sciencedirect.com/science/article/pii/S295013342400123XVA-ECMOprimary graft dysfunctionheart transplantationmechanical circulatory supportmeta-analysis |
| spellingShingle | Eduard Ródenas-Alesina, MD Aleix Olivella, MD Ani Orchanian-Cheff, MiST Farid Foroutan, PhD Yasbanoo Moayedi, MD, MSc Vivek Rao, MD, PhD Filio Billia, MD, PhD Heather J. Ross, MD, MHSc Ana Carolina Alba, MD, PhD Natasha Aleksova, MD, MSc Peripheral versus central cannulation of VA-ECMO for primary graft dysfunction after heart transplantation: A systematic review and meta-analysis JHLT Open VA-ECMO primary graft dysfunction heart transplantation mechanical circulatory support meta-analysis |
| title | Peripheral versus central cannulation of VA-ECMO for primary graft dysfunction after heart transplantation: A systematic review and meta-analysis |
| title_full | Peripheral versus central cannulation of VA-ECMO for primary graft dysfunction after heart transplantation: A systematic review and meta-analysis |
| title_fullStr | Peripheral versus central cannulation of VA-ECMO for primary graft dysfunction after heart transplantation: A systematic review and meta-analysis |
| title_full_unstemmed | Peripheral versus central cannulation of VA-ECMO for primary graft dysfunction after heart transplantation: A systematic review and meta-analysis |
| title_short | Peripheral versus central cannulation of VA-ECMO for primary graft dysfunction after heart transplantation: A systematic review and meta-analysis |
| title_sort | peripheral versus central cannulation of va ecmo for primary graft dysfunction after heart transplantation a systematic review and meta analysis |
| topic | VA-ECMO primary graft dysfunction heart transplantation mechanical circulatory support meta-analysis |
| url | http://www.sciencedirect.com/science/article/pii/S295013342400123X |
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