Heart Transplantation on Temporary MCS: A Single-Center Study (2010–2025)

R. Phinicarides (Düsseldorf)¹, V. H. Hettlich (Düsseldorf)², F. Jenkins (Düsseldorf)³, C. Böttger (Düsseldorf)⁴, F. Voß (Düsseldorf)¹, T. Zeus (Düsseldorf)¹, M. Kelm (Düsseldorf)¹, T. Zandberg (Düsseldorf)², N. Kalampokas (Düsseldorf)², B. Ramadani (Düsseldorf)², H. Aubin (Düsseldorf)⁵, A. Lichtenberg (Düsseldorf)², U. Boeken (Düsseldorf)^5
1Universitätsklinikum Düsseldorf Klinik für Kardiologie, Pneumologie und Angiologie Düsseldorf, Deutschland; ²Universitätsklinikum Düsseldorf Klinik für Herzchirurgie Düsseldorf, Deutschland; ³UKD Herzchirurgie Düsseldorf, Deutschland; ⁴Universitätsklinikum Düsseldorf Institut für Diagnostische und Interventionelle Radiologie Düsseldorf, Deutschland; ⁵Universitätsklinikum Düsseldorf Klinik für Kardiovaskuläre Chirurgie Düsseldorf, Deutschland

Background: Temporary mechanical circulatory support (tMCS) is increasingly used to stabilize patients in cardiogenic shock as a bridge-to-transplant (BTT). While this strategy facilitates listing and organ allocation in critically ill patients, its effect on post-transplant outcomes remains incompletely defined.
Methods: We conducted a single-center retrospective cohort study including all adult patients undergoing orthotopic heart transplantation (HTX) between September 2010 and October 2025. Patients were stratified by presence or absence of tMCS at the time of transplant.
Primary endpoints were resternotomy, perioperative extracorporeal life support (ECLS), in- hospital mortality, and one-year mortality. Student’s t-test and Chi-square tests were used for comparisons.
Results: Among 296 patients (mean age 55.2 ± 10.8 years; 70.6% male), 15 (5.1%) received tMCS at the time of HTX. Compared to controls, tMCS patients had significantly higher inflammatory markers and lower platelet and hemoglobin levels preoperatively. They were more often listed with high urgency (78.6% vs. 39.4%, p<0.01), required perioperative ECLS more frequently (64.3% vs. 26.9%, p<0.01), and exhibited higher in-hospital (21.4% vs.7.6%, p<0.01) and one-year mortality (54.5% vs. 16.7%, p<0.01). Resternotomy rates were similar. Patients bridged with Impella or transitioned from ECMO to RVAD had better outcomes than those transplanted directly from ECLS.
Conclusion: HTX in tMCS-supported patients is feasible but associated with significantly higher early and mid-term mortality. The type of preoperative support and transition strategy may impact outcomes. Tailored bridging concepts and early conversion to durable or RVAD- based support warrant further investigation.