Heart Transplantation Bridged by Extracorporeal Life Support in the Korean Adults: A 15 Year Single Center Experience

Abstract

Although extracorporeal life support (ECLS) is an effective treatment for a heart failure patient with cardiogenic shock, ECLS is typically replaced by a durable left ventricular assist device (LVAD) for a bridge to heart transplantation (HT). Because a durable LVAD is still not available in many countries including Korea, ECLS is continued until HT to investigate the impact of ECLS as a bridge to HT on survival after surgery, we reviewed our experience. From December 2003 to December 2018, 262 adult patients underwent HT in our institution. In a final cohort of 257 cases, we defined patients who had HT during ECLS as ECLS group (n = 116). The mean age of overall patients was 50.3 ± 13.6 years with a median age of 53 years (in the range of 18 to 78). There were 79 female patients (30.7%). In ECLS group, the mean duration of ECLS before HT was 15.7 ± 18.5 days with a median duration of 10.5 days (in the range of 1 to 125). 30-day mortality was 3.9% (n = 10; 6.9% in ECLS group and 1.4% in no-ECLS group; p = 0.024). The incidence of pre-HT ECLS was the statistically significant predictor of 30-day mortality (p = 0.041). The level of total bilirubin was the independently significant predictor of 30-day mortality and overall mortality (p < 0.001). There was no statistically difference in survival between two groups (p = 0.062). The survival of ECLS group was reasonably good. In countries with short waiting time for high urgency HT, ECLS as a bridge to HT is a viable option. Because waiting time for HT is getting longer in Korea, we will need not only ECMO or extracorporeal LVAD but also durable LVAD as a bridge to HT in near future.