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J Chest Surg

Published online January 27, 2021

Copyright © Journal of Chest Surgery.

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

Jae Jun Lee , M.D., Young Su Kim , M.D., Suryeun Chung , M.D., Dong Seop Jeong , M.D., Ph.D., Ji-Hyuk Yang , M.D., Ph.D., Kiick Sung , M.D., Ph.D., Wook Sung Kim , M.D., Ph.D., Tae-Gook Jun , M.D., Ph.D., Yang Hyun Cho , M.D., Ph.D.

Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to:Yang Hyun Cho
Tel 82-2-3410-1677
Fax 82-2-3410-6986
E-mail yanghyun.cho@samsung.com
ORCID
https://orcid.org/0000-0003-1685-3641

Received: September 16, 2020; Revised: November 6, 2020; Accepted: November 11, 2020

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properlycited.

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 ECLSbridged 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: Heart transplantation, Extracorporeal circulation, Extracorporeal membrane oxygenation, Patient care team, Multidisciplinary team approach

Article

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J Chest Surg

Published online January 27, 2021

Copyright © Journal of Chest Surgery.

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

Jae Jun Lee , M.D., Young Su Kim , M.D., Suryeun Chung , M.D., Dong Seop Jeong , M.D., Ph.D., Ji-Hyuk Yang , M.D., Ph.D., Kiick Sung , M.D., Ph.D., Wook Sung Kim , M.D., Ph.D., Tae-Gook Jun , M.D., Ph.D., Yang Hyun Cho , M.D., Ph.D.

Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to:Yang Hyun Cho
Tel 82-2-3410-1677
Fax 82-2-3410-6986
E-mail yanghyun.cho@samsung.com
ORCID
https://orcid.org/0000-0003-1685-3641

Received: September 16, 2020; Revised: November 6, 2020; Accepted: November 11, 2020

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properlycited.

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 ECLSbridged 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: Heart transplantation, Extracorporeal circulation, Extracorporeal membrane oxygenation, Patient care team, Multidisciplinary team approach

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