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BTT-ECMO Trends and Outcomes Under Revised Heart Allocation System

Aniket S Rali1,2, Het Patel3, Matthew M Lander4

  • 1Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.

JHLT Open
|March 27, 2025
PubMed

Insights

The revised heart allocation system benefits patients bridged to transplant with VA-ECMO (venovenous-arterial extracorporeal membrane oxygenation), maintaining favorable outcomes and reducing waitlist mortality.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Medical Devices

Background:

  • The revised UNOS heart allocation system aimed to improve outcomes for critically ill patients.
  • The use of VA-ECMO (venovenous-arterial extracorporeal membrane oxygenation) for bridging patients to heart transplant has increased.
  • Long-term persistence of improved outcomes under the new system for BTT-ECMO patients was unclear.

Purpose of the Study:

  • To evaluate the sustained impact of the revised UNOS heart allocation system on waitlist and post-transplant outcomes for patients bridged with VA-ECMO.
  • To assess trends in BTT-ECMO utilization and its association with patient outcomes after heart transplantation.

Main Methods:

  • Retrospective analysis of the UNOS database.
  • Inclusion of adult heart-only BTT-ECMO recipients from January 2019 to December 2022.
  • Evaluation of waitlist mortality and 1-year post-transplant outcomes.

Main Results:

  • Waitlist mortality remained favorable for BTT-ECMO patients under the revised allocation system.
  • One-year post-transplant outcomes were sustained at favorable levels.
  • Increased utilization of BTT-ECMO did not negatively impact these outcomes.

Conclusions:

  • The revised UNOS heart allocation system continues to ensure timely transplantation for the sickest patients bridged with VA-ECMO.
  • Sustained favorable waitlist and post-transplant outcomes support the effectiveness of the current allocation strategy.
  • The findings validate the system's goal of improving survival without increasing post-transplant mortality.

Keywords:
ECMOHeart transplantationOutcomesUNOS

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