Article Abstract

Five years’ experience with a peripheral veno-arterial ECMO for mechanical bridge to heart transplantation

Authors: Vitaly Poptsov, Ekaterina Spirina, Anastasiya Dogonasheva, Elizaveta Zolotova

Abstract

Background: Mechanical circulatory support (MCS) is the only way to save a life for heart transplant candidates and to decrease of waiting list mortality. The choice between short- or long-term pretransplant MCS depends on of type and severity of CHF. One of the most frequently used methods of temporary MSC before heart transplantation (OHTx) is Veno-Arterial Extracorporeal Membrane Oxygenation (VAECMO). The aim of this study was to analyze own experience of peripheral VAECMO (pVAECMO) in heart transplant candidates needed in urgent HT.
Methods: This study included 182 pts [160 (87.9%) men and 22 (12.1%) female, age 43±1.2 yrs] supported with pVAECMO in the period from 01. 01. 2013 to 31. 12. 2017 or 23.2% from all waiting list (n=786).
Results: During VAECMO, 16 (8.8%) of the 182 pts died. In most pts [n=13 (81.2%)] multiorgan failure/sepsis were the cause of death. 166 (91.2%) pts were successfully bridged to OHTx or 27.9% from all heart transplant recipients (n=594) (2013–2017 yrs). The duration of pVAECMO before OHTx (n=166) was 5.8±3.2 days. 143 (86.1%) from 166 pts were discharged to home. Post-transplant survival among heart transplant recipient with pre-transplant MCS by pVAECMO was in comparison with recipients without pretransplant MCS [84.2% vs. 90.1% (6 months), 83.3% vs. 91.8% (1 years), 75.1% vs. 86.1% (2 years), 74.2% vs. 85.8% (3 years), 72.3% vs. 84.7% (4 years), 72.3% vs. 83.5% (5 years) respectively (P<0.0001)].
Conclusions: pVAECMO is a useful tool of treatment of patients with INTERMACS profile 1/2. Results of OHTx at recipients bridged with VAECMO are less successful that recipients without pre-transplant MCS. VAECMO should be considered as a direct bridge to OHTx in conditions of limited financial resources of health care and high availability of donor's hearts.

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