Differential Short-term Survival in Patients Bridged with Biventricular Devices Versus Extracorporeal Membrane Oxygenation in the Contemporary Era of Heart Transplantation

Abstract

Background A recent trend favoring donor allocation to sicker patients has led to a rise in the number of patients undergoing heart transplantation (HT) on Extracorporeal membrane oxygenation (ECMO) support. Traditionally, these sick patients in cardiogenic shock were managed with biventricular support while awaiting HT. In this context, we examined short-term survival in patients bridged with biventricular devices (BiVAD) or ECMO in the contemporary era of heart transplantation before the change in the donor allocation strategy. Methods We identified adult patients listed for HT who were bridged with an ECMO or BiVAD between 2000 and 2018 in the Scientific Registry of Transplant Recipients. We compared 30-day and 1-year survival with the Kaplan-Meier method. Using inverse propensity treatment 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, or ECMO, respectively. The patients in ECMO group had higher prevalence of pre-transplant ventilator support (30.7% vs 6.3%, p Conclusions A minority of patients on BiVAD and ECMO support underwent HT. Besides, the transplantation rate was disproportionately lower in patients on ECMO support. Patients with heart failure bridged to HT with an ECMO experienced worse short-term post-transplant survival. This observation favors a relook into the current heart transplant allocation strategy.