Survival after heart transplantation in patients on ECMO support at the time of transplant improved over time in a high-volume center

Abstract

Pre-heart transplantation (HTx) ECMO support has been associated with poor short-term post-transplant outcomes without improvement over time. To analyze post-HTx outcomes in patients on ECMO support at the time of transplant at our center according to the year of transplant. Selection and patients’ care in case of pre-HTx ECMO support changed over time: exclusion of emergency access to HTx of pre-ECMO HTx patients with creatinine clearance below 40 ml/min, systematic use of reperfusion line, frequent use of intra-aortic balloon pump in association to ECMO, continuation of ECMO support after HTx… We performed a retrospective single-center observational study. We included all consecutive heart transplantation performed at our center between 2008 and 2016. We aimed to compare outcomes between patients under ECMO support at the time of HTx to patients without. We compared two periods of time: 2008/2012 and 2013/2016. The primary outcome was all-cause mortality after HTx. A total of 682 patients met the inclusion criteria, including 161 patients (23.6%) under ECMO support at the time of HTx; 342 and 340 HTx were preformed in the period 2008–2012 and 2013–2016 respectively. Patients were mostly males (78.5%) and mean age was 49.9 ± 12.8 years. The use of pre-HTx ECMO increased over time (17% to 30%, P < 0.01). ECMO patients were younger but had a longer ischemic time compared to other patients. Whereas the survival after HTx was similar between the two periods in patients without pre-HTx ECMO support (1-year survival: 79% compared to 81%), we observed a significant improvement in survival for patients on ECMO in the 2013–2016 period compared to the 2008–2012 period (1-year survival: 73% compared to 85%, P = 0.02, Fig. 1 ). HTx in patients under ECMO support at the time of transplant achieved favorable outcomes with a significantly better survival in the most recent era.