Intra-Aortic Balloon Placement without Inotropes: A Shift in Practice for Higher Urgency Status for Patients Awaiting Heart Transplant?

Abstract

<h3>Purpose</h3> The donor heart allocation policy was changed in October 2018, allowing priority for waitlist candidates with intra-aortic balloon pump (IABP) support over those with inotropic support. The use of IABP has increased several-fold since the donor heart policy was put into effect in October 2018. We assessed the UNOS registry to determine if this increase was due to a shift in practice or due to increased patient instability. <h3>Methods</h3> We reviewed 128 patients in UNOS on IABP awaiting HTx April 1, 2017 - April 1, 2018, and compared them to the 446 patients in UNOS on IABP awaiting HTx November 1, 2018 - November 1, 2019. The patients were further divided into groups based on concomitant use of inotropic support and compared pre- and post-allocation change. 30-day and 1-year survival post-HTx were assessed. <h3>Results</h3> In the post-policy era period of 2018, the placement of IABP without inotropes increased by 3.4-fold compared to 1 year prior to the policy change. For all patients with IABP placement, time from listing to transplant was significantly shorter after the policy change. There was no difference in 30-day and 1-year survival (Table 1). <h3>Conclusion</h3> There appears to be a shift in practice where IABP support is used without inotropic support after the donor heart allocation policy change. This suggests that physicians are using IABP in place of intravenous inotropes to advocate for their patients for a higher urgency status and donor availability. This should be taken into account in the revision of future donor heart allocation policies.