Outcomes of Patients Supported with ECMO as a Bridge to Durable Mechanical Circulatory Support: An Analysis of the STS Intermacs Database

Purpose To analyze the clinical characteristics and outcomes of patients who were bridged with ECMO to durable mechanical circulatory support (dMCS). Methods Adult patients who received dMCS between Jan 2008 and Dec 2017, registered in INTERMACS were included. Baseline characteristics, outcomes, risk factors and adverse events were analyzed in patients supported by ECMO (ECMO group) prior to dMCS implantation, and compared with INTERMACS profile 1 patients not supported by ECMO (non-ECMO group). Results Patients bridged to dMCS on ECMO were younger, more likely to have acute heart failure, ischemic etiology, and a bridge to candidacy implantation compared to other INTERMACS profile 1 patients (Table 1). Patients who received dMCS on ECMO had 1, 6, and 12 month survival of 83.8%, 71.2%, and 66.1%, inferior to non-ECMO group patients (91.4% 81.7% and 75.4%, p<0.0001). Within the ECMO group, patients with chronic HF had worse survival at 12 months compared with patients with subacute or acute HF (59.1%,73.0 and 75.5%, p<0.0001). Older age was associated with poor outcome (p<0.0001), ECMO supported patients older than 62 years had 12-month survival of 56.2%. The proportion of heart transplantation at 2 years after dMCS was similar between the ECMO (30.8%) and non-ECMO (31.8%) groups (p=0.49). Using a multiphase parametric hazard model, we identified 2 different periods based on risk of death. ECMO supported patients had a high hazard for death in the first 6 months after implantation (HR: 2.18 (1.79-2.66), p<0.001) and a lower risk beyond 6 months (HR: 0.69 (0.53-0.91), p=0.0075). Mutivariate analysis showed that ECMO was an independent risk factor associated with poor outcome after dMCS (HR: 1.69 (1.37-2.09), p <0.0001). Conclusion Patients bridged by ECMO to dMCS have lower survival compared with other INTERMACS profile 1 patients. Older age and longer duration of HF are associated with worse outcomes. ECMO implantation was independently associated with poorer outcome. To analyze the clinical characteristics and outcomes of patients who were bridged with ECMO to durable mechanical circulatory support (dMCS). Adult patients who received dMCS between Jan 2008 and Dec 2017, registered in INTERMACS were included. Baseline characteristics, outcomes, risk factors and adverse events were analyzed in patients supported by ECMO (ECMO group) prior to dMCS implantation, and compared with INTERMACS profile 1 patients not supported by ECMO (non-ECMO group). Patients bridged to dMCS on ECMO were younger, more likely to have acute heart failure, ischemic etiology, and a bridge to candidacy implantation compared to other INTERMACS profile 1 patients (Table 1). Patients who received dMCS on ECMO had 1, 6, and 12 month survival of 83.8%, 71.2%, and 66.1%, inferior to non-ECMO group patients (91.4% 81.7% and 75.4%, p<0.0001). Within the ECMO group, patients with chronic HF had worse survival at 12 months compared with patients with subacute or acute HF (59.1%,73.0 and 75.5%, p<0.0001). Older age was associated with poor outcome (p<0.0001), ECMO supported patients older than 62 years had 12-month survival of 56.2%. The proportion of heart transplantation at 2 years after dMCS was similar between the ECMO (30.8%) and non-ECMO (31.8%) groups (p=0.49). Using a multiphase parametric hazard model, we identified 2 different periods based on risk of death. ECMO supported patients had a high hazard for death in the first 6 months after implantation (HR: 2.18 (1.79-2.66), p<0.001) and a lower risk beyond 6 months (HR: 0.69 (0.53-0.91), p=0.0075). Mutivariate analysis showed that ECMO was an independent risk factor associated with poor outcome after dMCS (HR: 1.69 (1.37-2.09), p <0.0001). Patients bridged by ECMO to dMCS have lower survival compared with other INTERMACS profile 1 patients. Older age and longer duration of HF are associated with worse outcomes. ECMO implantation was independently associated with poorer outcome.