Outcomes of Mechanical Circulatory Support Bridge From Extracorporeal Membrane Oxygenation Before Heart Transplantation

Patients with advanced heart failure or cardiogenic shock often require a mechanical circulatory support device (MCSD) before heart transplantation (HT). While extracorporeal membrane oxygenation (ECMO) is commonly used for emergent stabilization, transitioning to alternative MCSDs may optimize patients before transplant. Prior studies suggest worse outcomes with ECMO alone. We examined post-HT outcomes in patients bridged from ECMO to other MCSDs. We used the United Network for Organ Sharing (UNOS)/Organ Procurement & Transplantation Network (OPTN) database to identify adults (age ≥18) undergoing HT between 2018 and 2024 who required ECMO at listing. Patients were grouped as ECMO only or ECMO transitioned to left ventricular assist device (LVAD), right ventricular assist device (RVAD), biventricular assist device (BiVAD), or total artificial heart (TAH). Survival was assessed by Kaplan-Meier curves and Cox regression models; outcomes were compared across groups. Of 749 patients, 527 (70%) were supported with ECMO alone. Survival at 30 days, 1 year, and 5 years was similar between ECMO-only and ECMO-to-MCSD (p = 0.46) and across MCSD subtypes (p = 0.96). Right ventricular assist device patients had lower 1 and 5 year survival than ECMO-only (p = 0.004). Rates of rejection, stroke, dialysis, and pacemaker use were similar. Hospital stay was shorter in ECMO-to-MCSD (p = 0.019). Bridging from ECMO to HT using alternative MCSDs is not associated with worse survival or clinical outcomes. Transitioning may offer comparable results with reduced hospital stays.