Heart Transplantation on Temporary Mechanical Circulatory Support: A Single-Center Study (2010-2024).

Area of Science:

• Cardiology
• Transplantation Medicine
• Mechanical Circulatory Support

Background:

• Temporary mechanical circulatory support (tMCS) is increasingly utilized for cardiogenic shock patients awaiting heart transplantation (HTX).
• While tMCS aids in listing and organ allocation, its impact on post-HTX outcomes is not fully understood.

Purpose of the Study:

• To evaluate the outcomes of orthotopic heart transplantation (HTX) in patients supported with temporary mechanical circulatory support (tMCS) versus those without.
• To identify factors influencing post-transplant outcomes in tMCS recipients.

Main Methods:

• A single-center retrospective cohort study of 296 adult patients undergoing HTX from September 2010 to December 2024.
• Patients were stratified based on the presence or absence of tMCS at the time of transplant.
• Primary endpoints included resternotomy, perioperative extracorporeal life support (ECLS), in-hospital mortality, and one-year mortality.

Main Results:

• Fifteen patients (5.1%) received tMCS pre-HTX and presented with higher inflammatory markers and lower hemoglobin/platelet levels.
• tMCS patients had higher rates of urgent listing (78.6% vs. 39.4%), required perioperative ECLS (64.3% vs. 26.9%), and experienced greater in-hospital (21.4% vs. 7.6%) and one-year mortality (54.5% vs. 16.7%).
• Resternotomy rates were similar; however, bridging with Impella or transitioning from ECMO to RVAD showed better outcomes than direct ECLS to HTX.

Conclusions:

• Orthotopic heart transplantation in tMCS-supported patients is feasible but associated with significantly increased early and mid-term mortality.
• The specific type of preoperative support and the transition strategy are critical factors affecting patient outcomes.
• Further research into tailored bridging strategies and early conversion to durable or RVAD support is warranted.