Fifteen Years Experience of Direct Bridge with Veno-Arterial Extra-Corporeal Membrane Oxygenation to Heart Transplantation
Presented During:
Monday, April 29, 2024: 3:15PM - 3:30PM
Metro Toronto Convention Center
Posted Room Name:
Room 717
Abstract No:
272
Submission Type:
Abstract Submission
Authors:
mojgan laali (1), guillaume coutance (2), Shaida Varnous (3), guillaume hekimian (4), cosimo d'alessandro (4), pierre demondion (5), guillaume lebreton (5), pascal leprince (5)
Institutions:
(1) Pitie-Salpetrier Hospital, 0, France, (2) La Pitié - Salpêtrière, paris, france, (3) La Pitié - Salpêtrière, Paris, france, (4) La Pitié - Salpêtrière, Paris, France, (5) La Pitié - Salpêtrière Hospital, paris, NA
Submitting Author:
Mojgan Laali
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Pitie-Salpetrier Hospital
Pitie-Salpetrier Hospital
Co-Author(s):
guillaume coutance
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La Pitié - Salpêtrière
La Pitié - Salpêtrière
Shaida Varnous
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La Pitié - Salpêtrière
La Pitié - Salpêtrière
guillaume hekimian
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La Pitié - Salpêtrière
La Pitié - Salpêtrière
cosimo d'alessandro
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La Pitié - Salpêtrière
La Pitié - Salpêtrière
pierre demondion
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La Pitié - Salpêtrière Hospital
La Pitié - Salpêtrière Hospital
guillaume lebreton
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La Pitié - Salpêtrière Hospital
La Pitié - Salpêtrière Hospital
pascal leprince
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La Pitié - Salpêtrière Hospital
La Pitié - Salpêtrière Hospital
Presenting Author:
Mojgan Laali
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Pitie-Salpetrier Hospital
Pitie-Salpetrier Hospital
Abstract:
Objective: To evaluate outcomes of patients directly bridged with Veno-Arterial Extra-Corporeal Membrane Oxygenation (VA ECMO) to heart transplantation.
Methods: A single center retrospective study was realized on 1152 adult patients undergoing isolated cardiac transplantation between January 2007 and December 2021. Among these, patients bridged with a VA ECMO to transplantation (group ECMO, n=317) were compared to the other transplanted patients (group NoECMO, n=835). A period analysis (Era I 2007-13, n=97 vs Era II 2014-21, n=220) was performed for patients of group ECMO.
Results: Median duration of VA ECMO support before transplantation in the group ECMO was 8 days [4.00; 13.0]. Recipients of group ECMO were younger, with a better renal function, and a shorter time on waiting list before donor allocation. They were allocated to younger donors, with a longer ischemic time. Group ECMO and NoECMO showed similar 1-year mortality and 5-years survival: 21.07% vs. 21.13%, p=0.98, and 66.9% (95% CI 63.8%; 70.3%) vs. 67.8% (95% CI 62.8%; 73.3%, p=0.76). Period analysis of group ECMO showed improved 1-year mortality and 5-years survival in ERA II compared to ERA I: 18% vs. 29%, p=0.025 and 70.7% (95% CI 64.7%; 77.3%) vs. 60.8% (95% CI 51.8%; 71.4%, p=0.043). Better outcomes in ERA II were explained by the higher number of patients in whom ECMO support was systematically pursued after the transplantation (92% vs. 48%, p<0.001), mainly by a peripheral cannulation (99.51% vs. 57%, p<0.001).
Conclusions: VA ECMO as a direct bridge for heart transplantation shows similar outcomes than other transplanted patients, provided that time on waiting list could be short and systematic VA ECMO temporary support, with a peripheral approach, could be pursued after transplantation.
Methods: A single center retrospective study was realized on 1152 adult patients undergoing isolated cardiac transplantation between January 2007 and December 2021. Among these, patients bridged with a VA ECMO to transplantation (group ECMO, n=317) were compared to the other transplanted patients (group NoECMO, n=835). A period analysis (Era I 2007-13, n=97 vs Era II 2014-21, n=220) was performed for patients of group ECMO.
Results: Median duration of VA ECMO support before transplantation in the group ECMO was 8 days [4.00; 13.0]. Recipients of group ECMO were younger, with a better renal function, and a shorter time on waiting list before donor allocation. They were allocated to younger donors, with a longer ischemic time. Group ECMO and NoECMO showed similar 1-year mortality and 5-years survival: 21.07% vs. 21.13%, p=0.98, and 66.9% (95% CI 63.8%; 70.3%) vs. 67.8% (95% CI 62.8%; 73.3%, p=0.76). Period analysis of group ECMO showed improved 1-year mortality and 5-years survival in ERA II compared to ERA I: 18% vs. 29%, p=0.025 and 70.7% (95% CI 64.7%; 77.3%) vs. 60.8% (95% CI 51.8%; 71.4%, p=0.043). Better outcomes in ERA II were explained by the higher number of patients in whom ECMO support was systematically pursued after the transplantation (92% vs. 48%, p<0.001), mainly by a peripheral cannulation (99.51% vs. 57%, p<0.001).
Conclusions: VA ECMO as a direct bridge for heart transplantation shows similar outcomes than other transplanted patients, provided that time on waiting list could be short and systematic VA ECMO temporary support, with a peripheral approach, could be pursued after transplantation.
ADULT CARDIAC:
Cardiac Transplant and Mechanical Circulatory Support
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