Short‐term mechanical circulatory support devices as bridge to heart transplantation: A prospective single‐center experience in Argentina

Abstract

Background Patients with cardiogenic shock may require hemodynamic stabilization with short‐term mechanical circulatory support devices (ST‐MCS) such as extracorporeal membrane oxygenation (ECMO) and centrifugal pump (CP) as bridge to transplant (BTT). This study aims to describe ECMO and CP during BTT and after heart transplant. Methods A cohort of patients on ECMO or CP as BTT between April 2006 and April 2018 in a single hospital. Results Thirty‐seven consecutive patients with ECMO (n=14) or CP (n=23) were included. Acute kidney injury (AKI) was more prevalent during CP (28.6% vs. 69.6%, p=0.02). There were no differences in stroke, thrombosis, sepsis or vasoplegia. Bleeding (0 vs. 56.5%, p=0.0003) and reoperation (0 vs. 47.8%, p=0.002) were more frequent in CP group as well as mortality (0 vs. 7 [30.4%], p=0.03). The remaining 30 patients (81.1%) underwent heart transplantation, without differences in primary graft dysfunction, vasoplegia, reoperation for bleeding or hospital stay. Mortality was 23.3% at 30 days, similar in both groups, with no further deaths at median follow‐up of 44.2 months Conclusions In patients with cardiogenic shock, ST‐MCS with ECMO or CP as BTT are a lifesaving approach allowing successful transplantation in the majority of cases, with good short and long‐term survival.