Bridging strategies for heart-lung transplantation: Current concepts and mechanical support modalities

Heart-lung transplantation (HLTx) has become increasingly rare over the past decades. However, HLTx remains the only life-saving option for patients experiencing end-stage cardiopulmonary failure. In parallel, extracorporeal membrane oxygenation (ECMO) has emerged as an established bridging strategy to isolated heart or lung transplantation. The role of ECMO before HLTx remains poorly defined, with current evidence limited to small series and case reports. Bridging patients to HLTx is complex, as support must address both gas exchange and hemodynamic instability in a highly heterogeneous population. The choice and configuration of ECMO must therefore be personnalized, guided by the patient's underlying disease and the expected duration of support.