Temporal trends in the use and outcomes of temporary mechanical circulatory support as a bridge to cardiac transplantation in Spain. Final report of the ASIS-TC study

Abstract

We aimed to describe recent trends in the use and outcomes of temporary mechanical circulatory support (MCS) as a bridge to heart transplantation (HTx) in Spain. Retrospective case-by-case analysis of 1,036 patients listed for emergency HTx while on temporary MCS in 16 Spanish institutions from January 1st, 2010 to December 31st, 2020. Patients were classified in 3 eras according to changes in donor allocation criteria (Era 1: January 2010/May 2014; Era 2: June 2014/May 2017; Era 3: June 2017/December 2020). Over time, the proportion of candidates listed with intra-aortic balloon pumps decreased (Era 1=55.9%, Era 2=32%, Era 3=0.9%; p < 0.001), while the proportion of candidates listed with surgical continuous-flow temporary VADs (Era 1=10.6%, Era 2=32%, Era 3=49.1%; p < 0.001) and percutaneous VADs (Era 1=0.3%, Era 2=6.3%; Era 3=17.2%; p < 0.001) increased. Rates of HTx increased from Era 1 (79.4%) to Era 2 (87.8%), and Era 3 (87%) (p=0.004), while rates of death before HTx decreased (Era 1=17.7%; Era 2=11%, Era 3=12.4%; p=0.037) Median time from listing to HTx increased in patients supported with intra-aortic balloon pumps (Era 1=8 days, Era 2=15 days; p < 0.001) but remained stable in other candidates (Era 1=6 days; Era 2=5 days; Era 3=6 days; p=0.134). One-year post-transplant survival was 71.4% in Era 1, 79.3% in Era 2, and 76.5% in Era 3 (p=0.112). Preoperative bridging with ECMO was associated with increased 1-year post-transplant mortality (adjusted HR=1.71; 95% CI 1.15-2.53; p=0.008). During the period 2010 to 2020, successive changes in the Spanish organ allocation protocol were followed by a significant increase of the rate of HTx and a significant reduction of waiting list mortality in candidates supported with temporary MCS. One-year post-transplant survival rates remained acceptable.