Direct Advanced Therapy Off Veno-Arterial Extracorporeal Membrane Oxygenation Support: Impact of New Heart Allocation Policy on Early Outcomes

Purpose The new heart allocation policy initiated on 2018 designates patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) to the highest listing status. This study seeks to evaluate the impact of the policy change on our early outcomes following direct advanced therapy off VA-ECMO. Methods From January 2010 to September 2020, 495 adult patients were treated with VA-ECMO at our center. Of these, 67 patients were direct bridge to either orthotopic heart transplantation (OHT) or durable left ventricular assist device (LVAD). Outcomes obtained before (OLD group: N=51) and after (NEW group: N=16) the policy change were compared. The decision to proceed directly to advanced therapy was inability to wean off of VA-ECMO and recovery was not anticipated. Results After the new policy, the rate of OHT significantly increased (OLD: 7/51 patients [13.7%] vs. NEW: 10/16 patients [62.5%], P Conclusion Our experience shows that the new heart allocation policy significantly increased the rate of direct OHT in patients bridged by VA-ECMO to direct advanced therapy. There was also a trend to greater one year survival in the NEW group, suggesting that the new policy facilitated appropriate triage to OHT versus LVAD. Although further follow-up is necessary, critical patients on VA-ECMO requiring advanced therapy may benefit from this new heart allocation policy