LONGITUDINAL AND CONTEMPORARY OUTCOMES OF TEMPORARY MECHANICAL CIRCULATORY SUPPORT IN CARDIAC TRANSPLANTATION

Abstract

Background Use of temporary mechanical circulatory support (tMCS) has enabled hemodynamic stabilization among those awaiting heart transplantation (HT). We sought to evaluate contemporary trends of tMCS use and outcomes. Methods Adult OHT recipients from 2008-20 were identified in the United Network for Organ Sharing database who were supported by tMCS (intra-aortic balloon pump (IABP), support systems (Impella®), or extracorporeal membrane oxygenation (ECMO)) at time of transplant. We analyzed recipient and donor characteristics, waitlist, and post-transplantation outcomes. Results A total of 3,202 patients, 7.4% of total transplants, (2,691 IABP, 191 Impella, 320 ECMO) were included. Use of tMCS increased, even more after 2018, p<0.001, Figure 1. Those on ECMO were younger, more likely to be white, and have a history of end-stage renal disease than other tMCS, all p<0.05. Median waitlist times were longest for IABP (24 days, interquartile range (IQR) 8-75 days), vs. Impella (17, IQR 6-53 days), ECMO (8, IQR 3-39 days). There was no difference in post-transplant death in those on Impella vs IABP but death was higher in those on ECMO (adjusted HR 1.74, confidence interval 1.32-2.29). Those on ECMO had the highest risk of graft failure (26.7%) [IABP (16.9%), Impella (9.4%)], all p<0.001. Conclusion Over time, use of tMCS has increased steadily and more dramatically recently. The significant increase in use is probably due to the new allocation system, and further work is needed on resulting outcomes. [Formula presented]