Five years’ experience with a peripheral veno-arterial ECMO for mechanical bridge to heart transplantation

Orthotopic heart transplantation (OHTx) remains the gold standard for the therapy of patients with advanced heart failure (HF), having a 10-year survival rate of 50% and a satisfactory quality of post-transplant life (1). However, in conditions of increased demand for donor hearts, OHTx is available only for small and strictly selected patient pool with advanced HF (2,3). In the case of donor heart shortage and an expanding the pool of patients waiting for OHTx, it is necessary to apply the alternative approach to decrease the mortality rate in heart transplant waiting list (4). Implantable long-term left ventricular assist device (LVAD) is the leading method of MCS not only for heart transplant candidates but also patients that are ineligible for OHT (destination therapy) (5,6). More than 40% of heart transplantation has been performed in patients with LVAD according to ISHLT registry data (7). However, in some clinical situations, it is impossible for LVAD to significantly improve hemodynamics such as biventricular CHF (8). LVADs is associated with a risk of thromboembolic, hemorrhagic, infectious, and other complications (9). The high acquisition cost of the device and post-implantation management are also limiting factors due to economic considerations (10,11). In guaranteed availability of donor hearts short-term (temporary) MCS may be an alternative approach for heart transplant candidates who need an urgent OHTx procedure (12,13). One of the most frequently used methods of temporary MSC before heart transplantation is veno-arterial extracorporeal membrane oxygenation (VA ECMO) (13,14). In the last few years, heart transplant team of Shumakov National Medical Research Center of Transplantology and Artificial Organs (Moscow, Russian Federation) began to apply peripheral VA ECMO (pVA ECMO) as the leading method of pretransplant short-term MSC