{"id":"979eb67d7d52","type":"article","url":"https://hartvaat.nl/2021/04/01/va-ecls-bij-harttransplantatie-en-vad-centra-meta-analyse/","title":"VA-ECLS bij harttransplantatie en VAD-centra: meta-analyse","title_en":"Veno-Arterial Extracorporeal Life Support in Heart Transplant and Ventricle Assist Device Centres. Meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13080","source_url":"https://doi.org/10.1002/ehf2.13080","authors":["Mariusz Kowalewski","Kamil Zieliński","Mirosław Gozdek","Giuseppe Maria Raffa","Michele Pilato","Musab Alanazi","Martijn Gilbers","Sam Heuts","Ehsan Natour","Elham Bidar","Rick Schreurs","Thijs Delnoij","Rob Driessen","Jan Willem Sels","Marcel van de Poll","Paul Roekaerts","Michał Pasierski","Paolo Meani","Jos Maessen","Piotr Suwalski","Roberto Lorusso"],"significance":5,"published":"2021-04-01","source_date":"2021-04-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis of VA-ECLS outcomes at heart transplant and VAD centers showed that center expertise significantly influences survival, supporting regionalization of mechanical support for cardiogenic shock.","created":"2026-07-03T10:29:07Z","updated":"2026-07-03T13:28:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van venoarteriële extracorporele levenondersteuning bij harttransplantatie- en VAD-centra.","abstract_original":"AIMS: Because reported mortality on veno-arterial (V-A) extracorporeal life support (ECLS) substantially varies between centres, the aim of the current analysis was to assess the outcomes between units performing heart transplantation and/or implanting ventricular assist device (HTx/VAD) vs. non-HTx/VAD units in patients undergoing V-A ECLS for cardiogenic shock. METHODS AND RESULTS: Systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed using PubMed/MEDLINE databases until 30 November 2019. Articles reporting in-hospital/30-day mortality and centre's HTx/VAD status were included. In-hospital outcomes and long-term survival were analysed in subgroup meta-analysis. A total of 174 studies enrolling n = 13 308 patients were included with 20 series performed in non-HTx/VAD centres (1016 patients, 7.8%). Majority of patients underwent V-A ECLS for post-cardiotomy shock (44.2%) and acute myocardial infarction (20.7%). Estimated overall in-hospital mortality was 57.2% (54.9-59.4%). Mortality rates were higher in non-HTx/VAD [65.5% (59.8-70.8%)] as compared with HTx/VAD centres [55.8% (53.3-58.2%)], P < 0.001. Estimated late survival was 61.8% (55.7-67.9%) without differences between non-HTx/VAD and HTx/VAD centres: 66.5% (30.3-1.02%) vs. 61.7% (55.5-67.8%), respectively (P = 0.797). No differences were seen with respect to ECLS duration, limb complications, and reoperations for bleeding, kidney injury, and sepsis. Yet, weaning rates were higher in HTx/VAD vs. non-HTx/VAD centres: 58.7% (56.2-61.1%) vs. 48.9% (42.0-55.9%), P = 0.010. Estimated rate of bridge to heart transplant was 6.6% (5.2-8.3%) with numerical, yet not statistically significant, difference between non-HTx/VAD [2.7% (0.8-8.3%)] as compared with HTx/VAD [6.7% (5.3-8.6%)] (P = 0.131). CONCLUSIONS: Survival after V-A ECLS differed according to centre's HTx/VAD status. Potentially different risk profiles of patients must be taken account for before definite conclusions are drawn."}