• J. Thorac. Cardiovasc. Surg. · Mar 2023

    Multicenter Study

    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, and Michel Carrier.
    • Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada. Electronic address: pierre-emmanuel.noly@icm-mhi.org.
    • J. Thorac. Cardiovasc. Surg. 2023 Mar 1; 165 (3): 11381148.e11138-1148.e1.

    BackgroundThis 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).MethodsA 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.ResultsFifty-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.ConclusionsSequential bridging from ECMO to TAH-t followed by heart transplantation is a viable option for a group of highly selected patients.Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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