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Introduction: The use of veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) as a direct bridge to heart transplantation (BTT) is not common in adults worldwide. BTT with ECMO is associated with increased early/mid‐term mortality compared with other interventions. In low‐ and middle‐income countries (LMIC), where no other type of short‐term mechanical circulatory support is available, its use is widespread and increasingly used as rescue therapy in patients with cardiogenic shock (CS) as a direct bridge to heart transplantation (HT). Objective: To assess the outcomes of adult patients using VA‐ECMO as a direct BTT in an LMIC and compare them with international registries. Methods: We conducted a single‐center study analyzing consecutive adult patients requiring VA‐ECMO as BTT due to refractory CS or cardiac arrest (CA) in a cardiovascular center in Argentina between January 2014 and December 2022. Survival and adverse clinical events after VA‐ECMO implantation were evaluated. Results: Of 86 VA‐ECMO, 22 (25.5%) were implanted as initial BTT strategy, and 52.1% of them underwent HT. Mean age was 46 years (SD 12); 59% were male. ECMO was indicated in 81% for CS, and the most common underlying condition was coronary artery disease (31.8%). Overall, in‐hospital mortality for VA‐ECMO as BTT was 50%. Survival to discharge was 83% in those who underwent HT and 10% in those who did not, p <.001. In those who did not undergo HT, the main cause of death was hemorrhagic complications (44%), followed by thrombotic complications (33%). The median duration of VA‐ECMO was 6 days (IQR 3‐16). There were no differences in the number of days on ECMO between those who received a transplant and those who did not. In the Spanish registry, in‐hospital survival after HT was 66.7%; the United Network of Organ Sharing registry estimated post‐transplant survival at 73.1% ± 4.4%, and in the French national registry 1‐year posttransplant survival was 70% in the VA‐ECMO group. Conclusions: In adult patients with cardiogenic shock, VA‐ECMO as a direct BTT allowed successful HT in half of the patients. HT provided a survival benefit in listed patients on VA‐ECMO. We present a single center experience with results comparable to those of international registries. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of the new heart transplant (HT) allocation system in left ventricular assist device (LVAD) supported patients listed as bridge to transplantation (BTT). Methods: Adult patients who were listed for HT between October 18, 2016 and October 17, 2019, and were supported with an LVAD, enrolled in the UNOS database were included in this study. Patients were classified in the old or new system if they were listed or transplanted before or after October 18, 2018, respectively. Results: A total of 3261 LVAD patients were listed for transplant. Of these, 2257 were classified in the old and 1004 in the new system. The cumulative incidence of death or removal from the transplant list due to worsening clinical status at 360‐days after listing was lower in the new system (4% vs. 7%, P =.011). LVAD Patients listed in the new system had a lower frequency of transplantation within 360‐days of listing (52% vs. 61%, P <.001). A total of 1843 LVAD patients were transplanted, 1004 patients in the old system and 839 patients in the new system. The post‐transplant survival at 360 days was similar between old and new systems (92.3% vs. 90%, P =.08). However, LVAD patients transplanted in the new system had lower frequency of the combined endpoint, freedom of death or re‐transplantation at 360 days (92.2% vs. 89.6%, P =.046). Conclusion: The new HT allocation system has affected the LVAD‐BTT population significantly. On the waitlist, LVAD patients have a decreased cumulative frequency of transplantation and a concomitant decrease in death or delisting due to worsening status. In the new system, LVAD patients have a decreased survival free of re‐transplantation at 360 days post‐transplant. [ABSTRACT FROM AUTHOR]

Historically, adult congenital patients have longer waitlist time and worse outcomes on the heart transplant waitlist as well as poorer early post‐transplant survival. A new heart transplantation allocation system was implemented in the United States on October 18, 2018. The effect of the new allocation system on adult congenital patients is unknown. Adult congenital patients listed for transplantation between November 1, 2015 and September 30, 2019 registered in the United Network for Organ Sharing were included in the study. October 18, 2018 was used as the limit to distribute listed and transplanted patients into old and new groups. A total of 399 patients were listed for heart transplant only, 284 in the old system and 115 in the new system. Clinical characteristics were similar between both groups. The cumulative incidence of poor outcome on the transplant list was similar in both groups (P =.23), but the cumulative incidence of transplant was higher in the new system group (P <.009) and was associated with a shorter waitlist time. The one‐year post‐transplant outcome was similar between old and new groups (P =.37). The new allocation system has benefited adult congenital patients with increased cumulative frequency of transplantation without worsening short‐term survival after transplantation. [ABSTRACT FROM AUTHOR]

Background: Few studies directly compare outcomes between the most commonly used preservation solutions in pediatric heart transplantation in a large cohort of recipients. The purpose of this study is to investigate the effect of cardiac preservation solution on survival in pediatric heart transplant recipients. Methods: The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from 01/2004‐03/2018 for pediatric donor hearts. Saline, University of Wisconsin (UW), "cardioplegia," Celsior, and Custodiol preservation solutions were evaluated. The primary endpoints were recipient survival at 30 days, 1 year, and long term. Results: After exclusion criteria, 3012 recipients had preservation solution data available. The most common preservation solution used was UW in 1203 patients (40%), followed by Celsior in 542 (18%), cardioplegia in 461 (15%), saline in 408 (14%), and Custodiol in 398 (13%). Survival of recipients whose donor hearts were procured with UW was as follows: 97%—30 day, 92%—1 year; Celsior: 97%—30 day, 92%—1 year; cardioplegia: 97%—30 day, 91%—1 year; saline: 97%—30 day, 91%—1 year; and Custodiol: 96%—30 day and 92%—1 year. Analysis of Cox models for 30‐day and long‐term survival revealed no statistical differences when comparing UW to Celsior (p =.333), cardioplegia (p =.914), saline (p =.980), or Custodiol (p =.642) in adjusted models. Conclusions: There were no significant differences in 30‐day or 1‐year survival detected between commonly used preservation solutions in the pediatric heart transplant population. [ABSTRACT FROM AUTHOR]