Comparative Temporal Analysis of Morbidity and Early Mortality in Heart Transplantation with Extracorporeal Membrane Oxygenation Support: Exploring Trends over Time
Raquel López-Vilella,
Manuel Pérez Guillén,
Borja Guerrero Cervera,
Ricardo Gimeno Costa,
Iratxe Zarragoikoetxea Jauregui,
Francisca Pérez Esteban,
Paula Carmona,
Tomás Heredia Cambra,
Mónica Talavera Peregrina,
Azucena Pajares Moncho,
Carlos Domínguez-Massa,
Víctor Donoso Trenado,
Luis Martínez Dolz,
Pilar Argente,
Álvaro Castellanos,
Juan Martínez León,
Salvador Torregrosa Puerta,
Luis Almenar Bonet
Affiliations
Raquel López-Vilella
Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Manuel Pérez Guillén
Cardiovascular Surgery Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Borja Guerrero Cervera
Cardiology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Ricardo Gimeno Costa
Intensive Care Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Iratxe Zarragoikoetxea Jauregui
Department of Anesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Francisca Pérez Esteban
Intensive Care Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Paula Carmona
Department of Anesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Tomás Heredia Cambra
Cardiovascular Surgery Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Mónica Talavera Peregrina
Intensive Care Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Azucena Pajares Moncho
Department of Anesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Carlos Domínguez-Massa
Cardiovascular Surgery Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Víctor Donoso Trenado
Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Luis Martínez Dolz
Cardiology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Pilar Argente
Department of Anesthesiology and Critical Care, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Álvaro Castellanos
Intensive Care Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Juan Martínez León
Cardiovascular Surgery Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Salvador Torregrosa Puerta
Cardiovascular Surgery Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Luis Almenar Bonet
Heart Failure and Transplant Unit, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
Background/Objectives: The direct bridge to urgent heart transplant (HT) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support has been associated with high morbidity and mortality. The objective of this study is to analyze the morbidity and mortality of patients transplanted with VA-ECMO and compare the presumed differences between various eras over a 17-year timeline. Methods: This is a prospective, observational study on consecutive patients stabilized with VA-ECMO and transplanted with VA-ECMO from July 2007 to December 2023 at a reference center (98 patients). Objective variables were mortality and morbidity from renal failure, venous thromboembolic disease (VTD), primary graft dysfunction (PGD), the need for tracheostomy, severe myopathy, reoperation, post-transplant ECMO, vascular complications, and sepsis/infection. Results: The percentage of patients who reached transplantation without the need for mechanical ventilation has increased over the periods studied. No significant differences were found between the study periods in 30-day mortality (p = 0.822), hospital discharge (p = 0.972), one-year mortality (p = 0.706), or five-year mortality (p = 0.797). Survival rates in these periods were 84%, 75%, 64%, and 61%, respectively. Comorbidities were very frequent, with an average of 3.33 comorbidities per patient. The most frequent were vascular complications (58%), the need for post-transplant ECMO (57%), and myopathy (55%). The development of myopathy and the need for post-transplant ECMO were higher in recent periods (p = 0.004 and p = 0.0001, respectively). Conclusions: VA-ECMO support as a bridge to HT allows hospital discharge for 3 out of 4 transplanted patients. This survival rate has not changed over the years. The comorbidities associated with this device are frequent and significant.
