Background: Data on the outcome of veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) support as a bridge to replacement therapies are scarce. Objectives: We investigated the outcome of V-A-ECMO support after adult cardiac surgery as a bridge to ventricular assist device (VAD) implantation and/or heart transplantation. Methods: This is a retrospective, multicenter study recruiting patients who underwent heart transplantation or VAD implantation immediately after postcardiotomy V-A-ECMO for persistent heart failure at 14 European centers of cardiac transplantation from 2010 to 2024. Results: Ninety-four consecutive patients were treated at 14 European centers of cardiac transplantation from 2010 to 2024. In-hospital mortality after replacement therapy was 31.9%, while it was 35.2% (19/54 patients) after primary VAD implantation and 27.5% (11/40 patients) after primary heart transplantation (p = 0.429) after V-A-ECMO. Five-year all-cause mortality of the overall series was 52.4%. Five-year mortality was 66.0% after primary VAD and 32.7% after primary heart transplantation (adjusted HR 0.420, 95%CI 0.199–0.885). Sixty-four patients underwent heart transplantation any time after V-A-ECMO support and had a 5-year mortality rate of 34.9%, while it was 83.9% among 32 patients who received VAD support only (p < 0.0001). Conclusions: The present findings support a bridge policy to heart replacement in selected postcardiotomy V-A-ECMO patients. Primary heart transplantation after V-A-ECMO support may be associated with better survival. The small size of this series and its results suggest that a larger study is needed to confirm these findings and could strengthen external validity and enhance the applicability of the results across different healthcare settings.
Postcardiotomy veno-arterial membrane oxygenation as a bridge to heart replacement therapies
Vendramin I.;
2026-01-01
Abstract
Background: Data on the outcome of veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) support as a bridge to replacement therapies are scarce. Objectives: We investigated the outcome of V-A-ECMO support after adult cardiac surgery as a bridge to ventricular assist device (VAD) implantation and/or heart transplantation. Methods: This is a retrospective, multicenter study recruiting patients who underwent heart transplantation or VAD implantation immediately after postcardiotomy V-A-ECMO for persistent heart failure at 14 European centers of cardiac transplantation from 2010 to 2024. Results: Ninety-four consecutive patients were treated at 14 European centers of cardiac transplantation from 2010 to 2024. In-hospital mortality after replacement therapy was 31.9%, while it was 35.2% (19/54 patients) after primary VAD implantation and 27.5% (11/40 patients) after primary heart transplantation (p = 0.429) after V-A-ECMO. Five-year all-cause mortality of the overall series was 52.4%. Five-year mortality was 66.0% after primary VAD and 32.7% after primary heart transplantation (adjusted HR 0.420, 95%CI 0.199–0.885). Sixty-four patients underwent heart transplantation any time after V-A-ECMO support and had a 5-year mortality rate of 34.9%, while it was 83.9% among 32 patients who received VAD support only (p < 0.0001). Conclusions: The present findings support a bridge policy to heart replacement in selected postcardiotomy V-A-ECMO patients. Primary heart transplantation after V-A-ECMO support may be associated with better survival. The small size of this series and its results suggest that a larger study is needed to confirm these findings and could strengthen external validity and enhance the applicability of the results across different healthcare settings.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
