Methods The clinical data of 96 recipients who underwent heart transplantation in the Department of Cardiovascular Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University from March 1st, 2019 to August 31, 2022 were retrospectively analyzed. All 96 recipients were divided into the ECMO group (n=33) and the non-ECMO group (n=63) based on whether received ECMO as circulatory support. To compare continuous variables between groups, the unpaired Student′s t-test was used if the continuous data were normally distributed, while the Mann-Whitney U test was used when the continuous data were non-normally distributed. Chi-square test was used to compare categorical variables. Kaplan-Meier survival analysis was performed to make survival curves and were compared by using log-rank test. P<0.05 was considered statistically significant.
Results The circulatory support time in the ECMO group was 9.29 (3.23, 20.81) d and 6 recipients in the ECMO group also received percutaneous balloon atrial septostomy. There were statistical difference for the indexes of recipients including the waiting-list time, C-reactive protein, very-low-density lipoprotein, high-density lipoprotein, uric acid, AST, ALT, total bilirubin, history of cardiopulmonary resuscitation, history of pacemaker implantation, history of cardiac surgery and primary heart disease between the two groups (Z=438.50, 1 564.00, 900.00, 109.00, 1 583.50 and 1 556.50, t=2.28 and 1 157.50, χ2=32.29, 6.10, 9.87 and 18.24, all P<0.05). Moreover, the indexes including the cold ischemic time, cardiopulmonary bypass time, aortic clamping time, intraoperative red blood cell transfusion, intraoperative plasma infusion, intensive care unit stay time, mechanical ventilation time and postoperative ECMO application of recipients were statistically different between the two groups (Z=1 405.5, 1 235.5, 1 437.5, 1 192.5, 981.0, 1 567.5 and 1 587.0, χ2=28.46, all P<0.05). There were 19 recipients (57.6%) received ECMO postoperatively, which was statistically higher than that in the non-ECMO group (5 cases, 7.9%) (χ2=28.46, P<0.05). Compared with the non-ECMO group, the ECMO group had higher 30-day mortality (15.2% vs 3.2%, χ2=4.595, P<0.05), higher in-hospital mortality (21.2% vs 6.3%, χ2=4.715, P<0.05) and higher 1-year mortality (30.3% vs 11.1%, χ2=5.474, P<0.05). There was statistical difference for the cumulative survival rate between the ECMO group and the non-ECMO group (χ2=4.650, P<0.05). After excluding the death cases within 30 days after transplantation, there was no significant difference for the cumulative survival rate between the two groups (χ2=1.140, P>0.05).
Conclusions Although the overall prognosis patients with ECMO bridged heart transplantation recipients is worse than that of non-bridged recipients, it is still an effective treatment for patients with irreversible cardiogenic shock. Effective preoperative evaluation, well perioperative management and individualized postoperative anti-rejection treatment can further improve the long-term prognosis of ECMO bridged heart transplantation.