Veno-arterial extracorporeal membrane oxygenation as a bridge to heart transplantation for end-stage heart failure: a single-centre retrospective analysis

Heart transplantation is a key treatment for end-stage heart failure. However, few donors and long waits for transplant availability mean that patients may not receive the procedure in time. This study analysed the suitability of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation. This study was retrospective. This single-centre study took place in cardiac center of a tertiary hospital. The participants comprised 15 patients with end-stage heart failure. All 15 participants underwent heart transplantation under VA-ECMO–assisted circulation; six participants received extracorporeal cardiopulmonary resuscitation (ECPR). The mean age was 41.80 ± 16.00 years, and the mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 23.20 ± 5.80. The median preoperative ECMO support duration was 168.00 h (interquartile range [IQR], 132.00–216.00 h). All patients required preoperative mechanical ventilation. The mean surgical duration was 432.13 ± 65.43 min. Postoperative ECMO was maintained in seven cases, with a median duration of 72.00 h (IQR, 24.00–120.00 h). Three in-hospital deaths occurred, resulting in 12 successful discharges. The median postoperative intensive care unit stay was 11.00 d (IQR, 4.50–14.50 d), and the median postoperative hospital stay was 35.00 d (IQR, 20.50–55.50 d). The postoperative 30-day mortality rate was 20% (3/15). Patients who underwent ECPR had a higher 30-day mortality rate (33.3%, 2/6) than those who did not (11.1%, 1/9), though the difference was not statistically significant (P = 0.527). The cumulative 1-year survival rate for all 15 patients was 60%, while for the 12 discharged patients, it was 75%. VA-ECMO can effectively stabilize patients with end-stage heart failure, serving as a viable short-term bridge to heart transplantation for select individuals. Appropriate patient selection via risk factor stratification is necessary to improve short-term outcomes. Direct bridging to heart transplantation following ECPR is not an ideal therapeutic strategy and requires careful consideration of intermediate risk-mitigation steps.