VA-ECMO for cardiogenic shock in the contemporary era of heart transplantation: Which patients should be urgently transplanted?

Marlena V. Habal, Lauren Truby, Masahiko Ando, Hirohisa Ikegami, Arthur R. Garan, Veli K. Topkara, Paolo Colombo, Koji Takeda, Hiroo Takayama, Yoshifumi Naka, Maryjane A. Farr

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

With the impending United Network for Organ Sharing (UNOS) heart allocation policy giving VA-ECMO supported heart transplant (HT) candidates highest priority status (Tier 1), identifying patients in cardiogenic shock (CS) with severe and irreversible heart failure (HF) appropriate for urgent HT is critically important. In a center where wait times currently preclude this approach, we retrospectively reviewed 119 patients (ages 18-72) with CS from 1/2014 to 12/2016 who required VA-ECMO for >24 hours. Underlying aetiologies included postcardiotomy shock (45), acute coronary syndromes (33), and acute-on-chronic HF (16). Eighty-four percent of patients (100) had ≥1 contraindication to HT with 61.3% (73) having preexisting contraindications (eg, multiorgan dysfunction and substance abuse), and 68.1% (81) experienced preclusive complications (eg, renal failure, coagulopathy, and infection). Potential HT candidates were significantly more likely to survive to discharge (potential HT candidates 84.2% vs preexisting contraindications 43.8% vs contraindications developing on VA-ECMO 33.3%, P = 0.001). Among potential HT candidates, 11 (68.8%) were discharged without advanced therapies and 4 received durable left ventricular assist device (25.0%). Importantly, 1-year survival was 100% for the 11 patients with follow-up. Thus, further work is critical to define appropriate candidates for HT from VA-ECMO while avoiding preemptive transplantation in those with otherwise favorable outcomes.

Original languageEnglish (US)
Article numbere13356
JournalClinical Transplantation
Volume32
Issue number9
DOIs
StatePublished - Sep 2018
Externally publishedYes

Keywords

  • cardiogenic shock
  • heart transplantation
  • VA-ECMO

ASJC Scopus subject areas

  • Transplantation

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