BTT-ECMO Trends and Outcomes Under Revised Heart Allocation System
Aniket S. Rali, MD, FACC, FCCP,
Het Patel,
Matthew M. Lander,
Kaitlyn Brennan,
John Trahanas,
Kelly Schlendorf,
JoAnn Lindenfeld,
Manreet Kanwar
Affiliations
Aniket S. Rali, MD, FACC, FCCP
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN; Corresponding author: Aniket S. Rali, Vanderbilt University Medical Center, Division of Cardiovascular Diseases, 1215 21st Ave S 5th Floor, Nashville, TN 37232.
Het Patel
Department of Internal Medicine, Willis Knighton Health System, Shreveport, LA
Matthew M. Lander
Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA
Kaitlyn Brennan
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
John Trahanas
Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN
Kelly Schlendorf
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
JoAnn Lindenfeld
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
Manreet Kanwar
Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA
Under the revised UNOS heart allocation system, waitlist and post-transplant outcomes among patients bridged to transplant with VA-ECMO (BTT-ECMO) have improved. However, it remains largely unknown if these early trends have persisted over time. We queried the UNOS database for all adult heart-only BTT-ECMO recipients between January 2019 and December 2022. Our analysis shows that under the revised system, waitlist mortality and 1-year post-transplant outcomes have remained favorable, despite increased utilization of BTT-ECMO. This finding supports the original intent of the revised allocation system in ensuring more rapid transplantation of the sickest patients while avoiding a higher post-HT mortality.
