Int J Heart Fail.  2023 Apr;5(2):91-99. 10.36628/ijhf.2023.0013.

Direct Extracorporeal Membrane Oxygenation Bridged Heart Transplantation: The Importance of Multi-Organ Failure

• Lim JH
• Lee SY
• Ju MH
• Kim SH
• Choi JH
• Chon MK
• Lee SH
• Hwang KW
• Kim JS
• Park YH
• Kim J
• Chun KJ
• Lim MH
• Lee Ch
• Je HG

• KMID: 2547680
• DOI: http://doi.org/10.36628/ijhf.2023.0013

Abstract

Background and Objectives
Recently, approximately 40% of all heart transplantation (HTx) in South Korea are performed using the direct extracorporeal membrane oxygenation (ECMO) bridging method. We conducted a study to examine the clinical outcome of direct ECMO-bridged HTx and to investigate the impact of multi-organ failure (MOF).
Methods
From June 2014 to September 2022, a total of 96 adult patients who underwent isolated HTx at a single tertiary hospital were included in the study. The patients were sub-grouped into ECMO (n=48) and non-ECMO group (n=48), and the ECMO group was subdivided into awake (n=22) and non-awake (n=26) groups based on mechanical ventilator (MV) dependency. Baseline characteristics, 30-day, and 1-year mortality were analyzed retrospectively.
Results
The 1-year survival rate was significantly lower in the ECMO group (72.9% vs. 95.8%, p=0.002). There was a significant difference in the 30-day survival rate between the awake and non-awake ECMO groups (81.8% vs. 65.4%, p=0.032). In the univariate analysis of logistic regression for 1-year mortality, the odds ratio was 8.5 for ECMO bridged HTx compared to the non-ECMO group, 12.3 in patients who required MV (p=0.003), and 23 with additional hemodialysis (p<0.001).
Conclusions
Patients who required MV in ECMO bridged HTx showed higher preoperative MOF rates and early mortality than those extubated. When considering ECMO bridged HTx, the severity of MOF should be thoroughly investigated, and careful patient selection is necessary.

Keyword

Mechanical ventilation; Hepato-renal failure; Extracorporeal membrane oxygenation; Heart transplantation