Mechanical Circulatory Support for Heart Transplantation: A Comparison of Deployment of Life Support in Patients Bridged on Temporary vs. Durable Devices

C. Echieh¹, K. Wang², A. Ryan³, A. Cherian³, Y. Rohilla⁴, R. Hooker⁵, T. Kazui^6
1University of Arizona, Calabar, Cross River ²University of Arizona, Tucson, Tucson, Arizona ³University of Arizona, Tucson, Arizona ⁴Banner University Medical Center, Tucson, Arizona ⁵Corewell Health, Grand Rapids, Michigan ⁶The University of Arizona/ Banner University Medical Center Tucson, Tucon, Arizona

Purpose: Mechanical circulatory support (MCS) is associated with poor post-transplant outcomes.(1) Recently, durable left ventricular assist devices (LVADs) have been associated with predictable recovery.(2,3) Differing outcomes may result from differences in use of life-support. We aim to determine differences in deployment of life-support among patients transplanted using temporary and durable MCS.

Methods: The UNOS database was queried for isolated heart transplants done on the approved contemporary durable LVAD device and on temporary MCS delivered using extracorporeal membrane oxygenation and/or an intra-aortic balloon pump from January, 2018 to June 2022. Transplants that were done using devices that are no longer in clinical use were excluded. We also did not include transplants bridged on micro-axial pumps. The dataset was grouped by the type of bridging used, namely temporary and durable MCS. Analyses were done for the use of critical care and life support such as prolonged inotropes, prolonged ventilation, the requirement for dialysis, and a permanent pacemaker.

Results: A total of 16,363 patients were waitlisted and transplanted during the study period. The requirement for dialysis was significantly higher in the temporary MCS group compared to the durable LVAD group (17.8% vs. 14.5%; p = 0.02). Also, chronic steroid use was significantly higher in the temporary MCS group (5.8% vs. 3.6%; p< 0.01). The development of stroke was higher in the durable LVAD group (4.3% vs. 3.8%); however, this did not reach statistical significance. The requirement for prolonged ventilation was higher in the temporary MCS group (6.1 vs. 0.6; p< 0.01). Also, the requirement for prolonged IV inotropes and inhaled NO was significantly higher in the temporary MCS group (57.6% vs. 43.1% and 0.9% vs. 0.2%, respectively). The survival at 1000 days was 82% in the temporary MCS group and 80% in the durable LVAD group (p = 0.02).

Conclusion: Heart transplant recipients who were bridged with temporary MCS have increased utilization of critical care resources in the postoperative period; however, post-transplant survival was comparable. This may be related to the severity of the decompensation that indicated the circulatory support at the time of transplant. Bridging with durable LVAD may allow time for the management and optimization of patients with decompensated heart failure ahead of the transplant.

Identify the source of the funding for this research project: No funding