TOP1: Outcomes in Heart Transplant Recipients by Bridge-To-Transplant Strategy When Using the SherpaPak Cardiac Transport System

Abstract

Background: The last several years have seen a rise in the use of mechanical circulatory support (MCS) to bridge heart transplant recipients. This may be due to expanding indications for devices such as extracorporeal membrane oxygenation (ECMO), but also to changes in the UNOS allocation policy in 2018. A controlled hypothermic organ preservation system, the SherpaPak Cardiac Transport System (CTS), was also introduced in 2018 and has grown in utilization with reports of improved post-transplant outcomes. We present here a subgroup analysis in recipients bridged with various MCS devices in the GUARDIAN-Heart Registry. Methods: The GUARDIAN-Heart registry is an international, multicenter registry assessing outcomes after transplant using CTS preservation. A retrospective review of clinical outcomes in transplant recipients with ventricular assist devices (VAD), intra-aortic balloon pumps (IABP) and ECMO prior to transplant were examined using summary statistics. Further analysis with ongoing enrollment will be available for presentation. Results: A total of 373 heart transplant recipients with donor hearts transported using the CTS system were included in this analysis. VADs were used in 171 recipients, IABP in 165, and ECMO in 37 recipients. Average ischemic times were over 3.5 hours for all cohorts. Mean IMPACT scores increased across groups (VAD = 6.8, IABP = 9.4, ECMO = 15.9), as did the rates of severe PGD post-transplant (VAD = 4.7%, IABP 7.9%, ECMO 18.9%). However, overall one-year survival was excellent (LVAD = 90.3%, IABP = 94.1%, ECMO = 93.3%). Median ICU length of stay was longer in the EMCO cohort (13.0 days) compared to the LVAD and IABP cohorts (each 7.0 days), as well as total hospital length of stay at 27.0 (ECMO) compared to 21.5 (LVAD) and 18.0 days (IABP). Conclusions: Despite average ischemic times in excess of 3.5 hours, use of the SherpaPak CTS for recipients with various bridging strategies results in excellent survival.