Abstract Body (Do not enter title and authors here): Introduction
Heart transplantation (HT) is the gold standard for end-stage heart failure, but limited donor availability and increasing disease prevalence have necessitated the use of mechanical circulatory support (MCS) devices. There is a rising trend of MCS devices used as a bridge to transplant with variable outcomes. This study examines trends and outcomes of MCS devices, specifically Extracorporeal Membrane Oxygenation (ECMO) and Impella, used as bridges to HT.
Hypothesis
Impella support leads to better survival and post-transplant outcomes than ECMO.
Methods
A retrospective cross-sectional study was conducted using National Inpatient Sample data from 2016-2021. Trends in utilization and patient outcomes were compared for those who received ECMO and Impella as bridges to HT. International classification of disease (ICD-10) codes were used to extract the data.
Results
During the study period, 17,570 HTs were performed, with a rising trend in using MCS devices as a bridge to transplant, especially Impella. ECMO was used in 1,635 patients and Impella in 755 patients. The mean age of the study population was 52.5 years and 610 (25.5%) were female. Cardiogenic shock was more common among patients with Impella (94.04% vs. 67.28%, p<0.001). Severe sepsis (9.27% vs. 23.24%, p<0.001) and transplant failure (0% vs. 13.15%, p<0.001) were higher with ECMO use. Mortality was lower with Impella (1.99% vs. 27.22%, p<0.001). Hospital stay and costs were similar for both groups.
Conclusion
In patients undergoing HT, the use of the Impella device was associated with lower in-hospital mortality, severe sepsis, and transplant failure compared to ECMO.