Abstract 4147358: Outcomes of ECMO vs. Impella as a Bridge to Heart Transplant: A Nationwide Analysis in the United States

Introduction: Heart transplantation (HT) is the gold standard for end-stage heart failure, but limited donor availability and increasing disease prevalence have necessitated the use of mechanical circulatory support (MCS) devices. There is a rising trend of MCS devices used as a bridge to transplant with variable outcomes. This study examines trends and outcomes of MCS devices, specifically Extracorporeal Membrane Oxygenation (ECMO) and Impella, used as bridges to HT. Hypothesis: Impella support leads to better survival and post-transplant outcomes than ECMO. Methods: A retrospective cross-sectional study was conducted using National Inpatient Sample data from 2016-2021. Trends in utilization and patient outcomes were compared for those who received ECMO and Impella as bridges to HT. International classification of disease (ICD-10) codes were used to extract the data. Results: During the study period, 17,570 HTs were performed, with a rising trend in using MCS devices as a bridge to transplant, especially Impella. ECMO was used in 1,635 patients and Impella in 755 patients. The mean age of the study population was 52.5 years and 610 (25.5%) were female. Cardiogenic shock was more common among patients with Impella (94.04% vs. 67.28%, p<0.001). Severe sepsis (9.27% vs. 23.24%, p<0.001) and transplant failure (0% vs. 13.15%, p<0.001) were higher with ECMO use. Mortality was lower with Impella (1.99% vs. 27.22%, p<0.001). Hospital stay and costs were similar for both groups. Conclusion: In patients undergoing HT, the use of the Impella device was associated with lower in-hospital mortality, severe sepsis, and transplant failure compared to ECMO.