Objectives: Heart transplant (HT) is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to HT or after HT for refractory conditions like primary graft failure (1). In this study, we present our decade-long perioperative experience with HTs.
Materials and Methods: We retrospectively screened the data of 56 HT performed between 2014 and 2024 at our center. Among them 25 patients were included in the study and divided into 2 groups, namely pre and postoperative VA-ECMO support. The demographic data, preoperative diagnosis, HT operation time, duration of extracorporeal support, clinical and laboratory data, ECMO type (peripheral or central), complications and mortality of the patients were analyzed.
Results: Preoperative VA-ECMO support was performed in 7 cases as a bridge to emergent HT. The mean age of patients was 26.3 ± 17.1 years. All cases had dilated cardiomyopathy. The HT operation time was 7.7 ± 1.4 hours. The duration of VA-ECMO support was 17.3 ± 18.4 days. Peripheral VA-ECMO (femoral) was performed in 4 cases. Extracorporeal cardiopulmonary resuscitation (E-CPR) was performed in 3 patients. The ECMO pump and vascular cannula were changed in 2 patients due to complications. One patient who was re-transplanted died at hour 4 post-HT and another patient died on day 29 post-HT. Total mortality rate was 28.6% (2 patients).
Postoperative VA-ECMO support was performed in 18 cases after HT. The mean age of patients was 31.5 ± 18.5 years. The main indication of this type of support was graft failure. Four of them had LVAD as a bridge to HT. The leading cause of end-stage heart failure was dilated cardiomyopathy (72.2%). The HT operation time was 8.6 ± 1.3 hours. The duration of VA-ECMO support was 8.8 ± 6.9 days. Peripheral VA-ECMO (femoral) was performed in 9 patients. E-CPR was performed in one patient. ECMO pump and vascular cannula were changed in 6 patients due to complications. Six patients died during the early postoperative ICU stay. Total mortality rate was 61.1% (11 patients).
Conclusions: In our group of HT recipients, preoperative VA-ECMO support had a lower mortality rate compared to VA-ECMO support in the post-transplant period. For patients on the HT list who are worsening despite optimal medical therapy, VA-ECMO support is a safe and viable last resort. Additionally, VA-ECMO support can be used during the postoperative period in HT patients with hemodynamic deterioration as salvage therapy.