Predictive factors of mortality with short-term ventricular assist devices for heart transplantation

INTRODUCTION AND OBJECTIVES: The shortage of donor hearts has led to an increased use of temporary mechanical circulatory support as a bridge to urgent heart transplantation (HT). This study aimed to identify predictors of in-hospital mortality in patients supported with short-term ventricular assist devices (VADs), specifically CentriMag and Impella, as a bridge to HT, used either as direct implantation or following prior extracorporeal membrane oxygenation support (ECMO). METHODS: Retrospective, single-center, observational study conducted at a tertiary care center, including all patients receiving short-term VADs, specifically CentriMag and Impella, as a bridge to HT between 2016 and 2024. RESULTS: A total of 73 patients were included: 22 received VAD following prior ECMO support (27.3% underwent transplantation; 50% in-hospital mortality post-transplant), and 51 underwent direct VAD implantation (80.4% underwent transplantation; 9.8% in-hospital mortality post-transplant). Independent predictors of in-hospital mortality included: use of CentriMag as left-sided VAD, acute coronary syndrome (ACS), VAD implantation following prior ECMO support, infection, and female sex. After adjustment for confounding variables, prior ECMO support before VAD implantation remained significantly associated with increased in-hospital mortality. CONCLUSIONS: The complex nature of patients requiring short-term VADs and the physiological impact of different devices must be addressed early and individually, based on the etiology of the shock and urgency status. In-hospital mortality was significantly higher among patients previously supported with ECMO, which highlights the importance of timely and optimized management to mitigate complications and enhance outcomes.