Abstract：
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has gained traction as a bridge to heart transplantation (HT) but remains associated with increased waitlist mortality. This study explores whether this risk is modified by underlying heart failure (HF) etiology.
METHODS: Using the Organ Procurement and Transplantation Network registry, we conducted a retrospective review of first-time adult HT candidates from 2018 through 2022. Patients were categorized as \"ECMO\", if ECMO was utilized during the waitlisting period, or \"No ECMO\" otherwise. Patients were then stratified according to the following HF etiology: ischemic cardiomyopathy (CMP), dilated nonischemic CMP, restrictive CMP, hypertrophic CMP, and congenital heart disease (CHD). After baseline comparisons, waitlist mortality was characterized for ECMO and HF etiology using the Fine-Gray regression.
RESULTS: A total of 16 143 patients were identified of whom 7.0% (n = 1063) were bridged with ECMO. Compared to No ECMO patients, ECMO patients had shorter waitlist durations (46.3 vs. 185.0 days, p < 0.01) and were more likely to undergo transplantation (75.3% vs. 70.3%, p < 0.01). Outcomes analysis revealed that ECMO was associated with increased mortality risk (subdistribution hazard ratio [SHR]: 3.42, p < 0.01), a risk that persisted in all subgroups and was notably high in CHD (SHR: 4.83, p < 0.01) and hypertrophic CMP (SHR: 9.78, p < 0.01). HF etiology comparison within ECMO patients revealed increased mortality risk with CHD (SHR: 3.22, p < 0.01). Within No ECMO patients, hypertrophic CMP patients had lower mortality risk (SHR: 0.64, p = 0.03).
CONCLUSIONS: The increased waitlist mortality risk with ECMO persisted after stratification by HF etiology. These findings can help decision-making surrounding candidacy for cannulation and prognostic evaluation.
METHODS: Using the Organ Procurement and Transplantation Network registry, we conducted a retrospective review of first-time adult HT candidates from 2018 through 2022. Patients were categorized as \"ECMO\", if ECMO was utilized during the waitlisting period, or \"No ECMO\" otherwise. Patients were then stratified according to the following HF etiology: ischemic cardiomyopathy (CMP), dilated nonischemic CMP, restrictive CMP, hypertrophic CMP, and congenital heart disease (CHD). After baseline comparisons, waitlist mortality was characterized for ECMO and HF etiology using the Fine-Gray regression.
RESULTS: A total of 16 143 patients were identified of whom 7.0% (n = 1063) were bridged with ECMO. Compared to No ECMO patients, ECMO patients had shorter waitlist durations (46.3 vs. 185.0 days, p < 0.01) and were more likely to undergo transplantation (75.3% vs. 70.3%, p < 0.01). Outcomes analysis revealed that ECMO was associated with increased mortality risk (subdistribution hazard ratio [SHR]: 3.42, p < 0.01), a risk that persisted in all subgroups and was notably high in CHD (SHR: 4.83, p < 0.01) and hypertrophic CMP (SHR: 9.78, p < 0.01). HF etiology comparison within ECMO patients revealed increased mortality risk with CHD (SHR: 3.22, p < 0.01). Within No ECMO patients, hypertrophic CMP patients had lower mortality risk (SHR: 0.64, p = 0.03).
CONCLUSIONS: The increased waitlist mortality risk with ECMO persisted after stratification by HF etiology. These findings can help decision-making surrounding candidacy for cannulation and prognostic evaluation.
摘要：
背景：体外膜氧合（ECMO）已成为心脏移植（HT）的桥梁，但仍与候诊者死亡率增加有关。这项研究探讨了潜在的心力衰竭（HF）病因是否改变了这种风险。
方法：使用器官采购和移植网络注册，我们对2018年至2022年首次成年HT候选人进行了回顾性审查.患者被归类为“ECMO”，如果在等待上市期间使用了ECMO，或“无ECMO”否则。然后根据以下HF病因对患者进行分层：缺血性心肌病（CMP），扩张的非缺血性CMP，限制性CMP，肥厚性CMP,先天性心脏病（CHD）。基线比较后，使用Fine-Gray回归分析ECMO和HF病因的候补死亡率。
结果：共发现16.143例患者，其中7.0％（n=1063）使用ECMO桥接。与无ECMO患者相比，ECMO患者的候诊者持续时间较短（46.3vs.185.0天,p<0.01），并且更有可能进行移植（75.3％vs.70.3%,p<0.01)。结果分析显示，ECMO与死亡风险增加相关（子分布风险比[SHR]：3.42，p<0.01），该风险在所有亚组中都持续存在，并且在CHD（SHR：4.83，p<0.01）和肥厚性CMP（SHR：9.78，p<0.01）中明显较高。ECMO患者的HF病因比较显示CHD死亡风险增加(SHR:3.22,p<0.01)。在没有ECMO患者中，肥厚性CMP患者的死亡风险较低(SHR:0.64,p=0.03).
结论：根据HF病因进行分层后，ECMO的候补名单死亡风险增加仍然存在。这些发现可以帮助决定插管和预后评估的候选人资格。
方法：使用器官采购和移植网络注册，我们对2018年至2022年首次成年HT候选人进行了回顾性审查.患者被归类为“ECMO”，如果在等待上市期间使用了ECMO，或“无ECMO”否则。然后根据以下HF病因对患者进行分层：缺血性心肌病（CMP），扩张的非缺血性CMP，限制性CMP，肥厚性CMP,先天性心脏病（CHD）。基线比较后，使用Fine-Gray回归分析ECMO和HF病因的候补死亡率。
结果：共发现16.143例患者，其中7.0％（n=1063）使用ECMO桥接。与无ECMO患者相比，ECMO患者的候诊者持续时间较短（46.3vs.185.0天,p<0.01），并且更有可能进行移植（75.3％vs.70.3%,p<0.01)。结果分析显示，ECMO与死亡风险增加相关（子分布风险比[SHR]：3.42，p<0.01），该风险在所有亚组中都持续存在，并且在CHD（SHR：4.83，p<0.01）和肥厚性CMP（SHR：9.78，p<0.01）中明显较高。ECMO患者的HF病因比较显示CHD死亡风险增加(SHR:3.22,p<0.01)。在没有ECMO患者中，肥厚性CMP患者的死亡风险较低(SHR:0.64,p=0.03).
结论：根据HF病因进行分层后，ECMO的候补名单死亡风险增加仍然存在。这些发现可以帮助决定插管和预后评估的候选人资格。
