Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used as a bridge to heart transplantation (HTx). Progression of multi-organ failure during ECMO is a well-known poor prognostic factor for mortality after HTx. Thus, maintaining isolated cardiac failure before HTx is important, and keeping a ventilator-free state (awake ECMO) could be one of these efforts. The purpose of this study is to compare the clinical outcome of ECMO-applied recipients who underwent HTx with or without ventilator.
Methods: From June 2014 to June 2022, a total of 89 patients who underwent HTx in a single tertiary hospital were included. Baseline characteristics, short-term, and long-term clinical data were collected prospectively and analyzed retrospectively. The recipients were divided into three groups as follows: group A, non-ECMO; group B, awake-ECMO; group C, ventilator-ECMO.
Results: The baseline characteristics of each group are presented in Table. Group C showed significantly higher total bilirubin and renal replacement rate than other groups (Table). There was statistically significant difference in the 30-day survival rate between the three groups: (A, 100%; B, 100%; C, 81.8%; P=0.048). However, the long-term survival rate showed no significant difference between the B and C groups (Figure).
Conclusions: The early survival rate was significantly higher in the awake-ECMO group compared with the ventilator-ECMO group, implying that the isolated heart failure state affects the short-term survival rate after HTx. Further large volume investigation is warranted.