Scientific publications
Impact of left ventricular unloading on postheart transplantation outcomes in patients bridged with VA-ECMO
Daniel Enríquez-Vázquez 1 , Eduardo Barge-Caballero 2 , Francisco González-Vílchez 3 , Luis Almenar-Bonet 4 , María Dolores García-Cosío Carmena 5 , José González-Costello 6 , Manuel Gómez-Bueno 7 , María Ángeles Castel-Lavilla 8 , Beatriz Díaz-Molina 9 , Manuel Martínez-Sellés 10 , Sonia Mirabet-Pérez 11 , Luis De La Fuente-Galán 12 , Daniela Hervás-Sotomayor 13 , Diego Rangel-Sousa 14 , Iris P Garrido-Bravo 15 , Teresa Blasco-Peiró 16 , Gregorio Rábago Juan-Aracil 17 , Javier Muñiz 18 , María G Crespo-Leiro 19
Introduction and objectives: The impact of preoperative left ventricular (LV) unloading on postoperative outcomes in patients bridged with venoarterial extracorporeal membrane oxygenation (VA-ECMO) to heart transplantation (HT) is unknown. Our aim was to compare posttransplant outcomes in patients bridged to HT with VA-ECMO, with or without the use of different mechanical strategies for LV decompression.
Methods: We conducted a retrospective analysis of the postoperative outcomes of consecutive HT candidates bridged with VA-ECMO, with or without concomitant LV unloading. Patients were included from 16 Spanish centers from 2010 to 2020. The primary endpoint was 1-year post-HT survival, which was assessed using Cox regression.
Results: Overall, 245 patients underwent high-emergency HT while supported with VA-ECMO. A mechanical strategy for LV unloading was used in 133 (54.3%) patients, with the intra-aortic balloon pump being the most commonly used method (n = 112; 84.2%). One-year posttransplant survival was 74.4% in the LV unloading group and 59.8% in the control group (P = .025). In multivariate analyses, preoperative LV unloading was independently associated with lower 1-year mortality (adjusted HR, 0.50; 95%CI, 0.32-0.78; P = .003). This association was observed both in patients managed with an intra-aortic balloon pump alone (adjusted HR, 0.52; 95%CI, 0.32-0.84; P = .007) and with other strategies for mechanical LV unloading (adjusted HR, 0.43; 95%CI, 0.19-0.97; P = .042). No significant differences were found between groups regarding other postoperative complications.
Conclusions: Preoperative LV unloading was independently associated with increased 1-year posttransplant survival in candidates bridged with VA-ECMO.
CITATION Rev Esp Cardiol (Engl Ed). 2024 Oct 9:S1885-5857(24)00296-2. doi: 10.1016/j.rec.2024.09.005
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