Veno-arterial Extracorporeal Membrane Oxygenation as Bridge to Heart Transplantation: The Way Forward

Andrea Montisci; Francesco Donatelli; Silvia Cirri; Enrico Coscioni; Ciro Maiello; Claudio Napoli

doi:10.1097/TXD.0000000000001172

Veno-arterial Extracorporeal Membrane Oxygenation as Bridge to Heart Transplantation: The Way Forward

Transplant Direct. 2021 Jul 8;7(8):e720. doi: 10.1097/TXD.0000000000001172. eCollection 2021 Aug.

Authors

Andrea Montisci¹, Francesco Donatelli^{2

3}, Silvia Cirri¹, Enrico Coscioni⁴, Ciro Maiello⁵, Claudio Napoli^{6

7}

Affiliations

¹ Department of Anesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Milan, Italy.
² Department of Cardiac Surgery, Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Milan, Italy.
³ Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
⁴ Department of Cardiac Surgery, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
⁵ Cardiac Transplantation Unit, Department of Cardiac Surgery and Transplantation, Ospedali dei Colli, Naples, Italy.
⁶ Clinical Department of Internal Medicine and Specialistic Units, Regional Referring Centre for Clinical Immunology of Organ Transplantation (LIT), University Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
⁷ IRCCS-SDN, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy.

Abstract

Advanced heart failure (HF) represents a public health priority due to the increase of affected patients and the meaningful mortality. Durable mechanical circulatory support (MCS) and heart transplantation (HTx) are unique therapies for end-stage HF (ESHF), with positive early and long-term outcomes. The patients who underwent HTx have a 1-y survival of 91% and a median survival of 12-13 y, whereas the median survival of ESHF is <12 mo. Short-term MCS with veno-arterial extracorporeal membrane oxygenation (VA ECMO) can be used as a bridge to transplantation strategy. Patients bridged with VA ECMO have significantly lower survival in comparison with non-MCS bridged and left ventricular assist device-bridged patients. VA ECMO represents an effective, and sometimes unique, system to obtain rapid hemodynamic stabilization, but possible negative effects on patients' outcomes after HTx must be considered. Here, we discuss the use of VA ECMO as bridge to transplantation.