Extracorporeal Membrane Oxygenation as a Bridge to Total Artificial Hearts

Abstract

<h3>Purpose</h3> Given the increasing use of temporary mechanical circulatory support in patients with end stage heart failure, we sought to explore outcomes in patients bridged to total artificial heart (TAH) with extracorporeal membrane oxygenation (ECMO). <h3>Methods</h3> A prospectively maintained institutional database was used to identify all patients with end stage heart failure who underwent TAH implantation. The proportion of patients bridged to transplantation and overall survival were compared according to the need for ECMO as a bridge to TAH. <h3>Results</h3> Ninety-nine patients (age 53 [41, 60], male 84%, N=83) underwent TAH implantation between 2012 and 2021. Among these, 29% (N=29) were bridged with ECMO. Patients bridged with ECMO were similar in age (53 [41, 60] years], compared with patients without ECMO support (53 [45, 60], p=0.911), but a significantly lower proportion were male(66%, N=19 vs 91%, N=64, p=0.005). Idiopathic cardiomyopathy was the most common primary diagnosis in both groups (ECMO: 38%; without ECMO: 43%; p=0.570) and there were no significant differences in baseline LVEF (ECMO: 15 [10, 23] %; without ECMO: 19 [15, 25] %; p=0.109). A higher proportion of patients with ECMO had severe RV dysfunction (ECMO: 52%, N=15; without ECMO: 31%, N=22), and a significantly higher proportion were INTERMACS 1 (97%, N=29 vs 33%, N=23; p<0.001). The proportion of patients bridged to transplantation were similar (ECMO: 48%, N=14; without ECMO: 66%, N=46; p=0.152. The overall survival was similar between two groups (p=0.076, Figure). <h3>Conclusion</h3> Despite higher acuity of patients who are bridged to TAH with ECMO, the proportion of patients undergoing transplantation and the overall long-term survival were similar to patients who are not bridged with ECMO.