Waitlist Mortality and Transplantation in Patients Bridged with Biventricular Devices and Extracorporeal Membrane Oxygenation in the Contemporary Era of Heart Transplantation

Abstract

Background The patients in cardiogenic shock supported with Extracorporeal Membrane oxygenation (ECMO) or non-dischargeable biventricular mechanical support (BiVAD) are more likely to receive heart transplantation (HT) since the donor allocation system was revamped in 2018, to favor sick patients and reduce waitlist mortality. However, the patients' characteristics and outcomes bridged with BiVAD or ECMO and listed for HT in the contemporary era before the policy changed are not explored. Methods We queried the Scientific Registry of Transplant Recipients database for adults listed for HT with BiVAD or ECMO between 2000 and 2018. Recipient characteristics, including hemodynamic and biochemical variables, are compared between groups. The patients were followed until death, transplant, or end of data availability. Waitlist mortality and successful HT were compared using a Fine and Gray competing risk regression model adjusted for known risk factors. Results Of the 1495 patients identified, 868 (58.1%) and 627 (41.9%) were bridged with BiVAD or ECMO. Since 2004, a more significant proportion of patients were on BiVAD, but that trend reversed over the past 5 years with more candidates on ECMO (pTrend Conclusions In recent years, there has been a rise in patients bridged to HT with ECMO. However, patients on ECMO suffered higher waitlist mortality and lower transplantation rates. This could, in part, be explained by the sicker profile of patients on ECMO.