Impact of Preoperative Mechanical Support Following Heart Transplant

Purpose To determine if the type of non-dischargeable preoperative mechanical support (PMCS) in transplant recipients affects post-transplant outcomes. Methods The SRTR database was used to identify all adult heart transplants requiring PMCS, excluding multi-organ and redo transplants. Intra-aortic balloon pump (IABP), right ventricular assist device (RVAD), total artificial heart (TAH), and extracorporeal membranous oxygenation (ECMO) were identified as PMCS. Groups were compared using an analysis of variance and Chi-square test for continuous and categorical variables respectively. Kaplan-Meier analysis and a Cox model were utilized to examine long-term survival. Results 4,647 heart transplants requiring PMCS were identified. Recipients with IABP were associated with older age and smoking, and a significantly shorter waitlist time (p Conclusion With recent allocation system changes and use of more PMCS, better understanding of the impact of these therapies on transplant candidates is essential. Based on the finding that pretransplant ECMO is associated with significantly worse outcomes, it may be beneficial to avoid ECMO when clinically feasible.