Temporary mechanical circulatory support: insights and evolving strategies.

Area of Science:

• Cardiology
• Transplantation Medicine
• Mechanical Circulatory Support

Background:

• Patients awaiting cardiac transplantation (CT) face risks of sudden deterioration requiring mechanical circulatory support (MCS).
• Indian transplant centers encounter challenges like late referrals, low organ donation, and financial constraints.
• This study shares experience and evolving strategies for temporary MCS in CT patients.

Purpose of the Study:

• To evaluate the utilization and outcomes of temporary mechanical circulatory support (MCS) in patients listed for cardiac transplantation (CT).
• To identify strategies to improve outcomes in high-risk CT patients requiring emergent MCS.

Main Methods:

• Single-center retrospective analysis of temporary MCS implantations.
• Data collected from January 1, 2015, to December 31, 2019.
• Included patients listed for cardiac transplantation.

Main Results:

• 41 temporary MCS implantations in 35 patients (24 pre-transplant, 11 post-transplant).
• Veno-arterial extracorporeal membrane oxygenator was the most common modality (44.4%).
• In-hospital mortality was 48.5%; 90% survival in pre-transplant patients bridged to CT.
• MCS-related vascular injury occurred in 25.7% of patients.

Conclusions:

• Early planning and timely MCS improve outcomes for high-risk patients bridged to cardiac transplant.
• Developing standard operating protocols can reduce MCS-related vascular complications.
• Temporary MCS is a viable option for selected high-risk cardiac surgery patients.