Abstract 13537: Similar Long-term Survival in Patients Bridged With Biventricular Devices or Extracorporeal Membrane Oxygenation in the Contemporary Era of Heart Transplantation

Abstract

Introduction: A recent trend favoring donor allocation to sicker patients has led to a rise in the number of patients undergoing heart transplantation (HT) on ECMO or non-dischargeable biventricular mechanical circulatory devices (BiVAD). While suboptimal short-term outcomes of such patients have raised concerns, long-term outcomes are unknown. We examined long-term survival in patients bridged with BiVAD or ECMO in the contemporary era before the donor allocation policy changed. Methods: We identified the adult patients listed for HT and bridged with ECMO or BiVAD between 2000 and 2018 in the Scientific Registry of Transplant Recipients. We compared 3- and 5-year survival with the Kaplan-Meier method. Using overlap propensity score weighting, we constructed doubly-robust Cox proportional hazards regression models to determine the risk-adjusted influence of support type on survival. Results: Of the 1495 listings; 868 (58.1%) were bridged with BiVAD and 627 (41.9%) with ECMO. 730 underwent successful HT; 528 (72.3%) and 202 (27.7%) were bridged with BiVAD and ECMO, respectively. The ECMO group had higher prevalence of pre-transplant ventilator support (30.7% vs 6.3%, p<0.0001), dialysis (15.8% vs 8.0%, p-0.005), inotrope use (36.6% vs 22.4%, p<0.0001) and a higher IMPACT score (11.5 vs 5.5, p<0.0001). Unadjusted 3- and 5-year estimated survival were similar in BiVAD vs. ECMO patients (Figure). After risk-adjustment, BiVAD and ECMO patients had a similar 3-year (HR 1.32, 95% CI 0.80-2.00; p=0.1849) and 5-year survival (HR 1.31, 95% CI 0.88-1.95; p=0.1878). Conclusions: A minority of patients on BiVAD and ECMO underwent HT suggesting high complication and waitlist mortality rates. Besides, the transplantation rate was disproportionately lower in patients on ECMO compared to BiVAD support. Patients with heart failure bridged with BiVAD or ECMO experienced similar long-term outcomes despite worse clinical and hemodynamic profile of patients in the ECMO group.