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Abstract: Objective: Severely impaired patients may wait in France on a special and temporary high emergency national list (called SU). Some of these patients need mechanical circulatory support with ECMO. In order to compare two groups of patients on SU, who acceeded to heart transplantation (HT) with or without ECMO, we reviewed retrospectively 20 consecutive patients transplanted on SU between January2004 and September2007 in Rennes. Patients and methods: Among them, 10 were transplanted without ECMO and 10 others were implanted with a femoro-femoral ECMO before HT. Results: (1) Considering the group SU without pretransplantation ECMO: 2years survival rate was 70%. Mean hospital stay was 26.4 days. Three patients were implanted with ECMO for graft dysfunction during postoperative course, without inherent complication. None graft dysfunction occurred after initial hospitalization; (2) considering the group SU with pretransplantation ECMO: 2years survival rate was 90% (one early death). Mean hospital stay was 45 days with multiple complications due to the ECMO (leg''s ischemia: n =2; lung oedema: n =1; lymphorrhea: n =3, low flow requiring change of canulae: n =1). None graft dysfunction occurred after initial hospitalization. Conclusion: Althought we didn’t reach statistical significance, it seems that ECMO for patients in SU may be useful as bridge to transplant but with a higher morbidity than for similar patients transplanted without ECMO. Additional data from other transplant centers are needed to confirm our findings. [Copyright &y& Elsevier]

Abstract: Cardiogenic shock is the leading cause of in-hospital death for myocardial infarction. Despite therapeutic improvements, such as medical treatment with inotropes, myocardial revascularization, circulatory assistance can be an option. Intra-aortic balloon pumping is highly recommended in the presence of haemodynamic impairment. If the patient continues to deteriorate and cardiac function cannot maintain adequate circulation to prevent end-organ failure, several mechanical circulatory assist devices can be considered: extracorporeal membrane oxygenator (ECMO), Impella®… These devices should be used at tertiary centres either as bridge to recovery or as bridge to transplantation or as bridge to long-term left ventricle assist device. [ABSTRACT FROM AUTHOR]