A bridge-to-bridge approach to heart transplantation using ECMO and total artificial heart

Abstract Background This study aims to describe the outcomes after HT using a bridge-to-bridge strategy with a sequence of extracorporeal membrane oxygenation (ECMO) support followed by temporary total artificial heart implantation (t-TAH). Methods A retrospective, multicenter analysis of 54 patients who underwent t-TAH implantation following an ECMO for cardiogenic shock was performed (ECMO-t-TAH group). A control group of 163 patients who underwent t-TAH implantation as a direct bridge to transplantation (t-TAH group) was used to assess this strategy's impact on outcomes. Results Fifty-four patients, averaging 47±13 years old, underwent implantation of a t-TAH after 5.3±3.4 days of ECMO perfusion for cardiogenic shock. In the ECMO-t-TAH group, 20 patients (20/54,37%) died after t-TAH implantation and 57 patients (57/163,35%) died in the t-TAH group (Gray test; p=0.49). The top 3 causes of death of patients on t-TAH support were multisystem organ failure (40%), sepsis (20%), and neurological events (20%). Overall, 32 patients (32/54, 59%) underwent heart transplantation in the ECMO-t-TAH group, compared to 106 patients (106/163, 65%) in the t-TAH group (p=0.44). No significant difference in survival was observed at 6 months, 1, and 3 years after heart transplant (ECMO-t-TAH group: 94%, 87%, and 80% vs. 87%, 83%, and 76% in the t-TAH group, respectively). Deterioration of liver function (bilirubin, AST, and ALT levels on t-TAH) was associated with increased mortality before heart transplant in both groups. Conclusion Sequential bridging from ECMO to t-TAH followed by heart transplantation is a viable option for a group of highly selected patients.