To analyze the efficacy of intra-aortic balloon pump (IABP) as a bridging therapy for heart transplantation in patients with advanced heart failure and pulmonary hypertension (PH).

The clinical data of 478 recipients who received heart transplantation in Fuwai Hospital, Chinese Academy of Medical Sciences from January 2015 to December 2020 were retrospectively analyzed. The patients were divided into non-PH group (221 cases), IABP support PH group (50 cases) and non-IABP support PH group (207 cases) according to preoperative IABP bridging to heart transplantation. Echocardiographic parameters such as left ventricular ejection fraction (LVEF), left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVEDD), as well as hemodynamic data such as systolic pulmonary artery pressure (SPAP), diastolic pulmonary artery pressure (DPAP), mean pulmonary artery pressure (MPAP), pulmonary vascular resistance (PVR), pulmonary capillary wedge pressure (PCWP) and cardiac output (CO) were compared among the three groups. Changes in hemodynamic and laboratory parameters before and after IABP support were compared, the modified model for end-stage liver disease excluding the international normalized ratio (MELD-XI) score was used to assess improvement in liver and kidney function in recipients. We also observed in-hospital outcomes and long-term survival of recipients.

The preoperative serum creatinine of IABP support PH group was 107.2 (87.3, 131.0) μmol/L, which was significantly higher than that of the other two groups (H=6.5 and 2.5, P<0.05 for all); the SPAP, DPAP and MPAP measured at the preoperative evaluation of heart transplantation were (52±17), (27±9) and (36±10) mmHg, respectively, and the PVR was (3.5±1.8) Wood units (WU), which were higher than those of the other two groups (P<0.05 for all). There were no significant differences in recipient age, sex, primary diseases, preoperative cardiac implantable electronic device implantation history, cardiac functional classification, echocardiographic parameters, intravenous vasoactive drug application, panel reactive antibodies, and donor and donor heart parameters among the three groups (P>0.05 for all). After IABP support, SPAP, MPAP, DPAP, PCWP, LAD and LVEDD were decreased (t=6.4, 6.1, 5.2, 6.0, 3.9 and 2.3, P<0.05 for all), CO and systolic blood pressure were increased (t=-2.6 and -4.6, P<0.05 for all); N-terminal pro-brain natriuretic peptide and serum total bilirubin levels were decreased (Z=-3.7 and -2.5, P<0.05 for all). In addition, MELD-XI scores were decreased after IABP support (t=3.2, P<0.05). During hospitalization after heart transplantation, in-hospital mortality was 4.1% (9/221), 8.0% (4/50), and 2.9% (6/207) in the non-PH group, IABP support PH group and non-IABP support PH group, respectively, and the difference was not statistically significant (χ²=2.8, P>0.05). The postoperative IABP placement rates were 19.5% (43/221), 58.0% (29/50), and 13.0% (27/207) in the non-PH group, IABP support PH group and non-IABP support PH group, respectively, and the differences were statistically significant (P<0.05). Compared with the non-PH group and the non-IABP support PH group, the ICU length of stay and total length of stay were prolonged in the IABP support PH group (H=92.2, 88.2, 84.1 and 82.7, P<0.05 for all). The 1-year survival rate was 95.0%, 92.0% and 95.2%, the 3-year survival rate was 92.6%, 92.0% and 91.1%, and the 5-year survival rate was 90.1%, 92.0% and 89.5% in the non-PH group, IABP support PH group and non-IABP support PH group, respectively, and the differences were not statistically significant (P>0.05 for all).

IABP support can be used as a bridge to heart transplantation, which helps end-stage heart failure patients with severe PH to successfully transition to the transplant candidate cohort and reduce the risk of heart transplantation.