Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Comparison of Veno-arterial Extracorporeal Membrane Oxygenation Configurations for Patients Listed for Heart Transplantation

  • Jung Ae Hong (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ah-Ram Kim (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Min-Ju Kim (Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Dayoung Pack (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Junho Hyun (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sang Eun Lee (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jae-Joong Kim (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Pil Je Kang (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sung-Ho Jung (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Min-Seok Kim (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2022.12.15
  • Accepted : 2023.04.04
  • Published : 2023.08.01
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Abstract

Background and Objectives: Veno-arterial extracorporeal membrane oxygenation (VAECMO) as a bridge to eventual heart transplantation (HT) is increasingly used worldwide. However, the effect of different VA-ECMO types on HT outcomes remains unclear. Methods: This was a retrospective observational study of 111 patients receiving VA-ECMO and awaiting HT. We assessed 3 ECMO configuration groups: peripheral (n=76), central (n=12), and peripheral to central ECMO conversion (n=23). Cox proportional hazards regression and landmark analysis were conducted to analyze the effect of the ECMO configuration on HT and in-hospital mortality rates. We also evaluated adverse events during ECMO support. Results: HT was performed in the peripheral (n=48, 63.2%), central (n=10, 83.3%), and conversion (n=11, 47.8%) ECMO groups (p=0.133) with a median interval of 10.5, 16, and 30 days, respectively (p<0.001). The cumulative incidence of HT was significantly lower in the conversion group (hazard ratio, 0.292, 95% confidence interval, 0.145-0.586, p=0.001). However, there was no difference in in-hospital mortality (log-rank p=0.433). In the landmark analysis, in-hospital mortality did not differ significantly among the 3 groups. Although we did note a trend toward lower HT in the conversion group, the difference was not statistically significant. Surgical site bleeding occurred mainly in the central, while limb ischemia occurred mainly in the peripheral groups. Conclusions: We suggest that if patients are being stably supported with their initial ECMO configuration, whether it is central or peripheral, it should be maintained, and ECMO conversion should only be cautiously performed when necessary.

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References

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