We evaluated the use of extra-corporeal membrane oxygenation (ECMO) support as a direct bridge for heart transplantation in high-urgency (SuperUrgence 1) adult recipients.

Between January 2005 and December 2012, 81 patients supported with ECMO underwent high-urgency cardiac transplantation at our Institution (group SU1 ECMO). They were compared to 131 cardiac recipients who high-urgency transplantation during the same period (group SU1 NoECMO).

Forty-four patients were supported with a peripheral ECMO, while 37 patients were supported with a central ECMO. Mean duration of support before transplantation was 17±12 days. The following characteristics were significantly different between group SU1 NoECMO and group SU1 ECMO: among the recipients, age, 49 years vs. 44 years, p<0.01; age older than 50 years, 61% vs. 42%, p<0.01; waiting time>15 days, 45% vs. 16%, p<0.01; ischemic etiology, 24% vs. 40%, p=0.02; prior sternotomy, 14% vs. 59%, p<0.01; preoperative Implantable Cardioverter Defibrillator (ICD), 50% vs. 16%, p<0.01; preoperative ventilation, 6% vs. 41%, p<0.01; preoperative inotropes, 84% vs. 67%, p<0.01, glomerular filtration rate (GFR) 76 vs. 108, p<0.01. Donor characteristics were similar in both groups. The occurrence of primary graft dysfunction and one-year mortality in group SU1 NoECMO and group SU1 ECMO were 18% vs. 42%, p<0.01 and 23% vs. 28%, p=0.37. Five-year survival was 72% (group SU1 NoECMO) and 66% (SU1 ECMO), p=0.45. A period analysis of SU1 ECMO patients is resumed in Table 1.

In our experience, ECMO support is a reliable option for direct bridge to heart transplantation and it resulted in satisfactory outcomes as other high-urgency transplanted patients.
Abstract 0330 – Table: Period Analysis of SU1 ECMO PatientsEra I (2005-2008)Era II (2009-2012)PRECIPIENTEtiology DCM27%53%0,02Central ECMO66%25%<0,01Prior Sternotomy78%40%<0,01Preoperative Ventilation56%25%<0.01GFR921240,03DONORAge>5044%23%0,04RESULTSPrimary Graft Failure32%53%0,061-Year Mortality27%30%0,75