Impact of Temporary Preoperative Mechanical Support on Heart Transplant Outcomes

We sought to assess the impact of temporary preoperative mechanical circulatory support (TPMCS) on heart transplantation outcomes. A total of 4,060 adult heart transplants from June 1, 2006, to December 31, 2019, were identified in the Scientific Registry of Transplant Recipients database as having...

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Bibliographic Details
Published inASAIO journal (1992) Vol. 69; no. 3; p. 290
Main Authors Ganapathi, Asvin M, Benissan-Messan, Dathe Z, Mokadam, Nahush A, Henn, Matthew C, Lampert, Brent C, Hasan, Ayesha, Emani, Sitaramesh, Whitson, Bryan A
Format Journal Article
LanguageEnglish
Published United States 01.03.2023
Subjects
Adult
Heart Failure - etiology
Heart Failure - surgery
Heart Transplantation
Heart-Assist Devices
Hospital Mortality
Humans
Kaplan-Meier Estimate
Proportional Hazards Models
Retrospective Studies
Treatment Outcome
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Summary:We sought to assess the impact of temporary preoperative mechanical circulatory support (TPMCS) on heart transplantation outcomes. A total of 4,060 adult heart transplants from June 1, 2006, to December 31, 2019, were identified in the Scientific Registry of Transplant Recipients database as having TPMCS. Recipients were divided into groups based on their type of TPMCS: intra-aortic balloon pump (IABP), temporary ventricular assist device (VAD), biventricular assist device (BIVAD), and extracorporeal membrane oxygenation (ECMO). Perioperative outcomes and survival were compared among groups. Recipients with IABP were associated with older age, a smoking history, and a significantly shorter wait list time ( p < 0.01). Recipients with ECMO had a significantly increased in-hospital mortality as well as an increased incidence of dialysis ( p < 0.01). Kaplan-Meier analysis revealed worse 1 and 5 year survival for recipients with ECMO. Cox model demonstrated a significantly increased risk of mortality with BIVAD (hazard ratio [HR], 1.33; 95% CI, 1.12-1.57; p < 0.01) and ECMO (HR, 1.64; 95% CI, 1.33-2.03; p < 0.01). While patients with IABP have a survival comparable to patients without TPMCS or durable left VAD, outcomes for BIVADs and ECMO are not as favorable. Transplantation centers must continue to make careful choices about the type of TPMCS utilized before heart transplant.
ISSN:1538-943X
DOI:10.1097/MAT.0000000000001772