Use of Extracorporeal Membrane Oxygenation for Heart Graft Dysfunction in Adults: Incidence, Risk Factors, and Outcomes in a Multicentric Study

Abstract

The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiac graft dysfunction (GD) is usually decided on a case-by-case basis through team experience. We aimed to determine the incidence of VA-ECMO use after heart transplantation (HT), early- and long-term outcomes, and risk factors for need of VA-ECMO and for early mortality in these patients. We included 135 adult heart recipients who met the criteria of the last ISHLT definition for GD from 3 cardiac centers over a 10-year period. Pre-transplant, intra-operative, post-transplant, and donor characteristics were analyzed and compared between recipients with GD treated with (n=66) or without VA-ECMO (n=69). Multivariate analysis for the need of VA-ECMO and hospital mortality were performed. The mean follow-up was 66.2±45 months and was 100% complete. The overall incidence of GD (30%) and of VA-ECMO use increased over the time. We did not identify any pre-transplantation predictive factors for VA-ECMO use, but patients who required VA-ECMO had higher serum lactate levels and higher inotropes doses after HT. In the medical and VA-ECMO groups, the overall survival rates were 83% and 42% at 1 year, and 78% and 40% at 5 years, respectively. Delayed implantation of VA-ECMO and post-operative bleeding were strongly associated with increased hospital mortality. The incidence of GD increased over the time, and the need of VA-ECMO for patients with GD remains difficult to predict. The early mortality decreased over the time but remains high in patients who required VA-ECMO, especially in patients with a delayed implantation.