Key result
Pre-transplant ECMO is linked to significantly lower post-heart transplant survival compared to no MCS.
Why the study?
Many patients with end-stage HF awaiting heart transplantation progress to cardiogenic shock or severe low cardiac output and require MCS as a bridge to transplantation, prompting this assessment of post-transplant survival and complications according to pre-transplant MCS use.
Does pre-transplant mechanical circulatory support (ECMO or LVAD) affect overall survival after heart transplantation compared to no pre-transplant MCS in patients with end-stage heart failure?
Cohort (n=100)
No
Does pre-transplant mechanical circulatory support (ECMO or LVAD) affect overall survival after heart transplantation compared to no pre-transplant MCS in patients with end-stage heart failure?
Heart transplant recipients bridged with ECMO experienced significantly lower overall survival and more frequent postoperative organ dysfunction compared to those transplanted without pre-transplant mechanical circulatory support.
Answers are grounded in this paper and cite their sources.
Pre-transplant ECMO signals elevated post-transplant mortality risk; leaves open whether bridging strategy or illness severity primarily determines outcomes.
Background: Heart transplantation is considered the definitive treatment for patients with end-stage heart failure (HF). Many patients with end-stage HF progress to cardiogenic shock or severe low cardiac output states while on the waiting list and require mechanical circulatory support (MCS) as a bridge to transplantation. The primary endpoint of this study was to assess overall survival after heart transplantation according to pre-transplant MCS use. The secondary outcomes included postoperative complications, intensive care utilization, and perioperative transfusion requirements.Methods: This retrospective single-center study included recipients of heart transplantation. A total of 100 consecutive patients were categorized into three groups according to pre-transplant MCS use (ECMO, LVAD, and non-MCS groups). Follow-up was censored on February 28, 2026.Results: The mortality was significantly higher and the overall survival was significantly lower in the ECMO group than in the non-MCS group. Overall survival significantly differed among the three groups (log-rank P = 0.001), driven mainly by worse survival in the ECMO group than in the non-MCS group, whereas survival did not significantly differ between the ECMO and LVAD groups.Conclusions: The ECMO group showed a significantly worse survival than the non-MCS group, whereas survival did not significantly differ between the ECMO and LVAD groups, which was likely attributed to the small sample size of the LVAD group. Postoperative continuous renal replacement therapy and other markers of organ dysfunction were more frequent in the ECMO group and likely reflected the greater severity of illness in these patients rather than the independent risk factors.
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Kim et al. (2026) conducted a cohort in End-stage heart failure requiring heart transplantation (n=100). Pre-transplant mechanical circulatory support (ECMO or LVAD) vs. No pre-transplant mechanical circulatory support (non-MCS) was evaluated on Overall survival after heart transplantation (p=0.001). Pre-transplant ECMO use was associated with lower overall survival after heart transplantation compared to no mechanical circulatory support.
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