Double Bridge May Result Similar 5-year Outcome after Heart Transplantation

Abstract

<h3>Purpose</h3> The number of waitlisted patients requiring mechanical circulatory support (MCS) as a bridge to heart transplantation is increasing. The data concerning the results of double-bridge strategy are limited. We sought to investigate the post-transplant outcomes across the different bridge strategies. <h3>Methods</h3> We retrospectively reviewed a heart transplantation database from Jan 2009 to Jan 2019. Intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO), and ventricular assist devices (VAD) were the MCS that we investigated. The pre- and post-transplant characteristics and variables of patients bridged with the different types of MCS were collected. The post-transplant survival was compared using Kaplan-Meier survival analysis. <h3>Results</h3> A total of 251 heart transplants were reviewed; 115 were without MCS and 136 with MCS. The patients were divided to five groups: Group 1 (no MCS): n=115; Group 2 (IABP): n=15; Group 3 (ECMO): n=33; Group 4 (ECMO-VAD): double-bridge (n=59); Group 5 (VAD): n=29. Survival analysis demonstrated that the 3-year post-transplant survival rates were significantly different among the groups (Log-rank <i>p</i> < 0.001). There was no difference in survival between group 4(ECMO-VAD) and group 1(no MCS)1 (<i>p</i> = 0.136), or between group 4(ECMO-VAD) and group 5(VAD) (<i>p</i> = 0.994). Group 3(ECMO) had significantly inferior 3-year survival than group 4(ECMO-VAD) and group 5(VAD). <h3>Conclusion</h3> Double bridge may not lead to worse mid-term results in patients who have the opportunity to receive a transplantation. Initial stabilization with ECMO for critical patients before implantation of VAD might be considered as a strategy for obtaining an optimal post-transplant outcome.