Veno-Arterial Extracorporeal Membrane Oxygenation is a Viable Option as a Bridge to Heart Transplant

Abstract Objective Veno-arterial extracorporeal membrane oxygenation is a rescue therapy for patients in cardiogenic shock. We hypothesize that patients bridged to heart transplant with extra-corporeal membrane oxygenation (ECMO) have decreased survival. Methods The United Network of Organ Sharing database was retrospectively reviewed from 01/01/99-03/31/18 for heart transplant recipients. Recipients bridged with any form of mechanical support and those without support were compared to recipients bridged with ECMO. The primary endpoint was restricted mean survival time (RMST) through 16.7 years. Results Of 26,918 recipients, 15,076 required no pre-transplant mechanical support (56.0%). Support patients included: 9,321 with left ventricular assist devices (34.6%), 53 with right ventricular assist devices (0.2%), 258 with total artificial hearts (1.0%), 686 with biventricular assist devices (2.6%), 1,378 with intra-aortic balloon pumps (5.1%), and 146 required ECMO (0.5%). In the first 16.7 years post-transplant, compared to recipients bridged with ECMO, estimated adjusted RMST was higher in patients who required no mechanical support [16.6 months (14.0 to 19.4)], left ventricular assist device [16.5 months (99% CI: 13.9 to 19.2)], intra-aortic balloon pump [11.2 months (8.3 to 14.7)],and biventricular assist device [6.6 months (3.6 to 10.3)] patients. RMST in right ventricular assist device and total artificial heart patients were similar to ECMO. Conclusion Recipients bridged with ECMO were estimated to survive 16.6 months fewer than non-MCS recipients. Bridge to heart transplant with ECMO is a viable option and these patients should be considered as transplant candidates.