ECMELLA as a Bridge to Recovery after Heart Transplantation—A Case Series

Background: Veno-arterial extracorporeal membrane oxygenation (va-ECMO) is increasingly used to treat cardiogenic shock. Recent studies showed that additional left ventricular unloading using a microaxial pump (Impella) may be associated with lower mortality. After heart transplantation, data on the combined use of va-ECMO and Impella (ECMELLA) are scarce. The aim of this study was to characterize patients who received an “ECMELLA” procedure for primary graft failure after HTX.

Methods: This monocentric, retrospective study included patients who received ECMELLA therapy for primary graft failure after HTX at the University Hospital Duesseldorf in the period 2010–2024 (Ethics Reference No.: 4567). Patients who received only va-ECMO without Impella support were excluded. The decision for ECMELLA therapy was based on echocardiographic and clinical evaluation. All available patient- and procedure-related data were analyzed.

Results: Out of 329 available patient cases in the database, 8 ECMELLA patients (2.4%) were identified and included. Mean age of the cohort was 55 ± 10 years and 37.5% of the patients were female. The mean duration of ECMELLA support was 12 ± 8 days. The mean durations of surgery and cardiopulmonary bypass were 8 ± 2.4 hours and 4.7 ± 1.7 hours, respectively. Intraoperatively, patients received 14 ± 8 units of packed red blood cells (PRBC; 1 unit = 270 mL), and 11 ± 8 units of fresh frozen plasma (FFP; 1 unit = 300 mL). Postoperatively, patients received 61 ± 28 units PRBCs and 55 ± 27 units FFP. ⅞ of the included patients (87.5%) required early open-chest revision surgery. On average, patients remained in the intensive care unit for 45 ± 31 days. Postoperative duration of mechanical ventilation was 19 ± 14 days and every patient received renal replacement therapy. The survival rate after 30 days was 62.5%.

Conclusion: ECMELLA for primary graft failure after HTX is a resource-intensive procedure that may be associated with a favorable outcome in select patients. Future research should try to identify criteria which patients may benefit from ECMELLA after HTX.

Publication History

Article published online:
11 February 2025