Racial Differences in In-Hospital Outcomes after the Use of Temporary Mechanical Circulatory Support as a Bridge to Heart Transplant

Abstract

Purpose The use of temporary mechanical circulatory support (tMCS) as a bridge to heart transplant (HTx) (BTT) has increased over time, especially after implementation of the new adult heart allocation system. We sought to assess if racial differences existed in in-hospital outcomes among patients BTT with a tMCS. Methods The National Inpatient Sample was queried for all patients who were BTT with a tMCS [intra-aortic balloon pumps (IABP), percutaneous left-ventricular assist device (PVAD), or extracorporeal membrane oxygenation (ECMO)] between 2008 and 2017. Patients were stratified by race and evaluated for in-hospital, death, MACE, discharge disposition, and costs. Multivariable logistic regression was used to identify predictors of in-hospital mortality for each of the tMCS devices. Results Out of 5,063 HTx, 17.8% (901) who were bridged with a tMCS (IABP 577, ECMO 366, PVAD 80). The incidence of MACE (9.7% White vs. 8.6% Black vs. 9.0% Hispanic vs. 7.6% Others; p value 0.520), non-home discharge (17.5% White vs. 17.1% Black vs. 12.6% Hispanic vs. 15.5% Others; p value 0.056) and procedural costs [White $354,406.72 vs. Black $329,752.47 vs. Hispanic $482,146.45 vs. Others $384,841.00; p value p Conclusion Among patients BTT with a tMCS, there was no racial difference in in-hospital complications or death, irrespective of the type of tMCS used. With the recent change in the transplant allocation system, the use of tMCS as a BTT has increased, and the results herein highlight that in-patient outcomes prior to the allocation system change are similar among racial groups and may ensure equitable access to transplantation in the new system.