JTCVS Open. 2026 May 2;32:101851. doi: 10.1016/j.xjon.2026.101851. eCollection 2026 Aug.
ABSTRACT
OBJECTIVE: Various mechanical circulatory support (MCS) strategies exist to bridge patients with heart failure to heart transplant. This study provides a comprehensive analysis comparing perioperative transfusion requirements and posttransplant outcomes between recipients with various pretransplant MCS types.
METHODS: All adult heart transplants from January 2020 to June 2025 from a single-center, minus multiorgan transplants or adult congenital heart disease cases, were included. Patients were stratified as: no MCS, pretransplant intra-aortic balloon pump (IABP), Impella, durable left ventricular assist device (LVAD), and extracorporeal membrane oxygenation (ECMO).
RESULTS: A total of 600 adult heart transplants were included, of which 263 (43.8%) had no MCS, 91 (15.2%) an IABP, 47 (7.8%) an Impella, 179 (29.8%) a durable LVAD, and 20 (3.3%) had ECMO as pretransplant support. Intraoperative transfusion requirements were greater in the Impella, LVAD, and ECMO cohorts compared with the no-MCS cohort. Postoperatively, both LVAD and ECMO groups had greater transfusions relative to those without MCS. Transfusion requirements were similar between the LVAD and ECMO cohorts. The IABP, Impella, and LVAD groups had comparable posttransplant outcomes relative to the no-MCS group. The ECMO cohort had greater 30-day and 1-year mortality rates compared with those without pretransplant MCS.
CONCLUSIONS: Perioperative transfusion requirements were comparable between those with no pretransplant MCS and those with IABP or Impella and was greater in those with pretransplant LVAD or ECMO. Survival in patients with IABP, Impella, and LVAD was similar to those with no MCS and worse in patients with ECMO compared with no MCS.
PMID:42604197 | PMC:PMC13477139 | DOI:10.1016/j.xjon.2026.101851