Heart transplantation in patients transferred after emergent VA-ECMO from local secondary hospitals: a single-center experience in Korea

Background In Korea, the number of patients who undergo emergent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) at local secondary hospitals is increasing. For advanced heart-failure management, including heart transplantation (HT), some of those patients are subsequently transferred to tertiary centers. We report our single-center experience of patients transferred for HT after emergent VA-ECMO. Methods We retrospectively reviewed 11 consecutive patients transferred to our tertiary hospital after emergent VA-ECMO implantation at local secondary hospitals between December 2022 and May 2025. Clinical parameters—including ECMO duration, venting-catheter insertion, preoperative ejection fraction (EF), MELD-XI score, and surgical variables—were analyzed. Survivors were defined as patients discharged alive after ECMO weaning or transplantation. Clinical characteristics and outcomes were compared between survivors and non-survivors, and stratified analyses were performed for the HT subgroup and for acute myocardial infarction (AMI) versus non-AMI. Results Among the 11 patients, 7 (63.6%) survived to discharge; 6/7 (85.7%) in those who underwent HT (n=7) and 1/4 (25.0%) in those weaned without HT. The median ECMO duration was 22 days [IQR 20–26.5; range 16–50]. In the total cohort, ECMO duration (22 vs 24 days, p≈1.00), EF (22% vs 20%, p≈1.00), venting-catheter insertion (p≈1.00), and MELD-XI (8.5 vs 9.0, p≈1.00) did not differ between survivors and non-survivors. In the HT subgroup (n=7), the survival rate was 85.7% and was not associated with ECMO duration, EF, venting-catheter use, MELD-XI, cardiopulmonary-bypass time, or ischemic time (all p ≥ 0.31). When stratified by etiology, patients with AMI (n=7) showed a trend toward lower survival compared with non-AMI patients (42.9% vs 100%; p=0.19), while HT rates (57.1% vs 75.0%; p≈1.00) and ECMO duration (22 [18–26.5] vs 21.5 [21–24] days; p=0.85) were similar between groups. Conclusions Transferred patients on emergent VA-ECMO demonstrated acceptable overall survival, driven by high survival after HT (85.7%). Mortality was not significantly associated with etiology, ECMO duration, venting, EF, MELD-XI, or surgical variables, underscoring the primacy of timely referral and coordinated inter-hospital management over clinical parameters alone.