A bridge-to-bridge approach to heart transplantation using extracorporeal membrane oxygenation and total artificial heart

Pierre Emmanuel Noly, Jaime Moriguchi, Keyur B. Shah, Anelechi C. Anyanwu, Claudius Mahr, Eric Skipper, Mariève Cossette, Yoan Lamarche, Michel Carrier

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1 Scopus citations

Abstract

Background: This study aims to describe the outcomes after heart transplantation using a bridge-to-bridge strategy with a sequence of extracorporeal membrane oxygenation (ECMO) support followed by temporary total artificial heart implantation (TAH-t). Methods: A retrospective, multicenter analysis of 54 patients who underwent TAH-t implantation following an ECMO for cardiogenic shock was performed (ECMO-TAH-t group). A control group of 163 patients who underwent TAH-t implantation as a direct bridge to transplantation (TAH-t group) was used to assess this strategy's impact on outcomes. Results: Fifty-four patients, averaging 47 ± 13 year old, underwent implantation of a TAH-t after 5.3 ± 3.4 days of ECMO perfusion for cardiogenic shock. In the ECMO-TAH-t group, 20 patients (20/54%; 37%) died after TAH-t implantation and 57 patients (57/163%; 35%) died in the TAH-t group (Gray test; P = .49). The top 3 causes of death of patients on TAH-t support were multisystem organ failure (40%), sepsis (20%), and neurologic events (20%). Overall, 32 patients (32/54%; 59%) underwent heart transplantation in the ECMO-TAH-t group compared with 106 patients (106/163%, 65%) in the TAH-t group (P = .44). No significant difference in survival was observed at 6 months, 1 year, and 3 years after heart transplant (ECMO-TAH-t group: 94%, 87%, and 80% vs 87%, 83%, and 76% in the TAH-t group, respectively). Deterioration of liver function (bilirubin, aspartate transaminase, and alanine aminotransferase levels on TAH-t) was associated with increased mortality before heart transplant in both groups. Conclusions: Sequential bridging from ECMO to TAH-t followed by heart transplantation is a viable option for a group of highly selected patients.

Original languageEnglish
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - 2021

Keywords

  • biventricular failure
  • bridge-to-bridge strategy
  • extracorporeal membrane oxygenation
  • heart transplantation
  • total artificial heart

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