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

• Published in: Clinical transplantation 2024-06, Vol.38 (6), p.e15334-n/a
• Main Authors: Burgos, Lucrecia M., Chicote, Fiorella S., Vrancic, Mariano, Seoane, Leonardo, Ballari, Franco N., Baro Vila, Rocio C., De Bortoli, María A., Furmento, Juan F., Costabel, Juan P., Piccinini, Fernando, Navia, Daniel, Espinoza, Juan, Diez, Mirta
• Format: Article
• Language: English
• Subjects: Adult; cardiogenic shock; Developing Countries; Extracorporeal Membrane Oxygenation; Female; Follow-Up Studies; heart transplant; Heart Transplantation - mortality; Heart-Assist Devices - statistics & numerical data; Hospital Mortality; Humans; Male; Middle Aged; Prognosis; Retrospective Studies; Shock, Cardiogenic - etiology; Shock, Cardiogenic - mortality; Shock, Cardiogenic - therapy; Survival Rate; ventricular assist devices
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.15334

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