Predictive Factors of Mortality in Extracorporeal Membrane Oxygenation-Assisted Patients as a Bridge to Heart Transplantation.

Abstract

Objectives: To identify predictors of in-hospital mortality in patients listed for urgent heart transplantation (HT) who are supported by extracorporeal membrane oxygenation (ECMO).

Design: A retrospective, observational study of ECMO use as a bridge to HT from 2007 to 2024.

Setting: A single-center tertiary hospital.

Participants: 110 patients were included, of whom 100 underwent HT (90.9%).

Interventions: None.

Measurements and main results: The overall in-hospital mortality rate for the entire cohort was 31.8% (75 out of 110 patients survived). Among the patients who underwent HT, the in-hospital mortality rate was 25% (75 out of 100 patients survived). Multivariate analysis identified the following predictive factors for in-hospital mortality in the overall cohort: obesity, age, infection, and need for hemodialysis. In patients who underwent HT, the predictors of hospital mortality included age, need for hemodialysis, donor body mass index (BMI) < 10% (relative decrease in donor BMI < 10% compared to recipient BMI) and the requirement for invasive mechanical ventilation at the time of transplantation. Long-term mortality in HT recipients was independently predicted by age and a donor BMI < 10%.

Conclusions: Mechanical assist devices, such as ECMO, are frequently used as a bridge to heart transplantation HT. Morbidity and mortality remain high in this population. In this study, the duration of ECMO did not emerge as a predictor of mortality; however, the need for hemodialysis and older age were associated with higher mortality in both the overall cohort and the transplanted patients. Donor BMI was identified as a significant predictor of mortality in both the short term and long term.