Post-Cardiotomy Veno-Arterial Extracorporeal Life Support After Heart Transplantation: Data from the PELS-1 Multicenter Study

초록

Purpose: Veno-arterial extracorporeal life support (VA ECLS) is the first-choice mechanical circulatory support modus to overcome primary graft dysfunction, right ventricular failure, or severe vasoplegic syndrome after heart transplantation. Despite its life-saving role, the associated morbidity and mortality remain high. This study aimed to evaluate short- and long-term outcomes of patients requiring VA ECLS following heart transplantation and compare characteristics of patients who survived hospital discharge to those who did not. Methods: This international, multicenter, retrospective study, derived from the PELS-1 study, evaluated patients who required VA ECLS after heart transplantation between January 2000 and December 2020. Clinical, procedural, and ECLS-related data were collected. Outcomes were compared between hospital survivors and non-survivors. Follow-up survival was evaluated with Kaplan-Meier analysis. Results: Among 2058 post-cardiotomy ECLS patients, 209 required VA ECLS after heart transplantation (males: n=114, 55%) and 62% (n=130) of them survived to discharge. Median age was 56 years (42-67; survivors: 55 [44-62]; non-survivors: 58 [51-64]; p=0.014). A previous left ventricular assist device was present in 65 (31%) patients. Overall, 46 (33%) patients were treated with chest initially open. Intraoperative implantation occurred more frequently in survivors (survivors: n=102, 78%; non-survivors: n=52, 66%; p=0.040). Median ECLS duration was 4.5 days (2.8-6.9; survivors: 4.0 [2.7-5.8]; non-survivors: 6.0 [2.9-9.8]; p=0.005). Most common complications included bleeding (survivors: n=53, 43%; non-survivors: n=55, 71%; p<0.001), septic shock (survivors: n=7, 6%; non-survivors: n=29, 41%; p<0.001), right ventricular failure (survivors: n=16, 14%; non-survivors: n=19, 27%; p=0.030), and acute kidney injury (survivors: n=78, 67%; non-survivors: n=53, 76%; p=0.220). Survival probability at 10 years was 44% in the overall population and 73.5% in hospital survivors. Conclusion: Complications are frequent in VA ECLS after heart transplantations, especially in non-survivors. Nevertheless, hospital survival is higher than in patients requiring post-cardiotomy VA ECLS after other types of operations and almost three quarters of hospital survivors are still alive up to 10 years after surgery.