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

Temporary mechanical circulatory support (tMCS) is increasingly used to stabilize patients in cardiogenic shock as a bridge-to-transplant. While this strategy facilitates listing and organ allocation in critically ill patients, its effect on post-transplant outcomes remains incompletely defined.

We conducted a single-center retrospective cohort study including all adult patients undergoing orthotopic heart transplantation (HTX) between September 2010 and December 2024. Patients were stratified by presence or absence of tMCS at the time of transplant. Primary endpoints were resternotomy, perioperative extracorporeal life support (ECLS), in-hospital mortality, and 1-year mortality. Student's t-test and chi-square tests were used for comparisons.

Among 296 patients (mean age: 55.2 ± 10.8 years; 70.6% male), 15 (5.1%) received tMCS at the time of HTX. Compared with controls, tMCS patients had significantly higher inflammatory markers and lower platelet and hemoglobin levels preoperatively. They were more often listed with high urgency (78.6 vs. 39.4%, p < 0.01), required perioperative ECLS more frequently (64.3 vs. 26.9%, p < 0.01), and exhibited higher in-hospital (21.4 vs. 7.6%, p < 0.01) and 1-year mortality (54.5 vs. 16.7%, p < 0.01). Resternotomy rates were similar. Patients bridged with Impella or transitioned from extracorporeal membrane oxygenation to right ventricular-assist device (RVAD) had better outcomes than those transplanted directly from ECLS.

HTX in tMCS-supported patients is feasible but associated with significantly higher early and mid-term mortality. The type of preoperative support and transition strategy may impact outcomes. Tailored bridging concepts and early conversion to durable or RVAD-based support warrant further investigation.