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. 2024 Jun;38(6):e15334.
doi: 10.1111/ctr.15334.

Veno-arterial ECMO ventricular assistance as a direct bridge to heart transplant: A single center experience in a low-middle income country

Lucrecia M Burgos  1 , Fiorella S Chicote  2 , Mariano Vrancic  3 , Leonardo Seoane  4 , Franco N Ballari  1 , Rocio C Baro Vila  1 , María A De Bortoli  1 , Juan F Furmento  4 , Juan P Costabel  4 , Fernando Piccinini  3 , Daniel Navia  3 , Juan Espinoza  3 , Mirta Diez  1
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Veno-arterial ECMO ventricular assistance as a direct bridge to heart transplant: A single center experience in a low-middle income country

Lucrecia M Burgos et al. Clin Transplant. 2024 Jun.

Abstract

Introduction: The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a direct bridge to heart transplantation (BTT) is not common in adults worldwide. BTT with ECMO is associated with increased early/mid-term mortality compared with other interventions. In low- and middle-income countries (LMIC), where no other type of short-term mechanical circulatory support is available, its use is widespread and increasingly used as rescue therapy in patients with cardiogenic shock (CS) as a direct bridge to heart transplantation (HT).

Objective: To assess the outcomes of adult patients using VA-ECMO as a direct BTT in an LMIC and compare them with international registries.

Methods: We conducted a single-center study analyzing consecutive adult patients requiring VA-ECMO as BTT due to refractory CS or cardiac arrest (CA) in a cardiovascular center in Argentina between January 2014 and December 2022. Survival and adverse clinical events after VA-ECMO implantation were evaluated.

Results: Of 86 VA-ECMO, 22 (25.5%) were implanted as initial BTT strategy, and 52.1% of them underwent HT. Mean age was 46 years (SD 12); 59% were male. ECMO was indicated in 81% for CS, and the most common underlying condition was coronary artery disease (31.8%). Overall, in-hospital mortality for VA-ECMO as BTT was 50%. Survival to discharge was 83% in those who underwent HT and 10% in those who did not, p < .001. In those who did not undergo HT, the main cause of death was hemorrhagic complications (44%), followed by thrombotic complications (33%). The median duration of VA-ECMO was 6 days (IQR 3-16). There were no differences in the number of days on ECMO between those who received a transplant and those who did not. In the Spanish registry, in-hospital survival after HT was 66.7%; the United Network of Organ Sharing registry estimated post-transplant survival at 73.1% ± 4.4%, and in the French national registry 1-year posttransplant survival was 70% in the VA-ECMO group.

Conclusions: In adult patients with cardiogenic shock, VA-ECMO as a direct BTT allowed successful HT in half of the patients. HT provided a survival benefit in listed patients on VA-ECMO. We present a single center experience with results comparable to those of international registries.

Keywords: cardiogenic shock; extracorporeal membrane oxygenation; heart transplant; ventricular assist devices.

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References

REFERENCES

    1. Masarone D, Kittleson M, Petraio A, Pacileo G. Advanced heart failure: state of the art and future directions. Rev Cardiovasc Med. 2022;23(2):48. https://doi.org/10.31083/j.rcm2302048
    1. Guglin M, Zucker MJ, Bazan VM, et al. Venoarterial ECMO for adults: jACC scientific expert panel. J Am Coll Cardiol. 2019;73(6):698‐716. doi:10.1016/j.jacc.2018.11.038
    1. Fukuhara S, Takeda K, Kurlansky PA, Naka Y, Takayama H. Extracorporeal membrane oxygenation as a direct bridge to heart transplantation in adults. J Thorac Cardiovasc Surg. 2018;155(4):1607‐1618. doi:10.1016/j.jtcvs.2017.10.152
    1. Makdisi G, Wang I‐W. Extra corporeal membrane oxygenation (ECMO) review of a lifesaving technology. J Thorac Dis. 2015;7(7):E166‐176. doi:10.3978/j.issn.2072‐1439.2015.07.17
    1. Rihal CH, Naidu S, Givertz MM, Szeto WY, Burke JA, Kapur N, et al. SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care. Cathet Cardiovasc Intervent. 2015;85:E175‐E196.

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