Short-Term Mechanical Circulatory Support Before Heart Transplantation and Early Outcomes: Insights From the International Primary Graft Dysfunction Consortium.
Rivas-Lasarte M, Rodenas-Alesina E, et al. • Journal of cardiac failure • 2026
Although ECMO is associated with a greater risk of severe PGD, ST-MCS does not independently increase 1-year mortality after HT, supporting its use as a bridge in high-risk patients.
Key Findings
Results
Short-term mechanical circulatory support (ST-MCS) use before heart transplantation increased over time and varied by region across the study period.
Overall, 669 patients (17.6%) received pre-HT ST-MCS out of 3800 adult heart transplants at 14 centers.
The intra-aortic balloon pump (IABP) predominated in the United States, while ECMO was more frequently used in Canada and Europe.
The registry covered 14 centers in the United States, Canada, and Europe between 2010 and 2020.
Device distribution among ST-MCS patients: 60.4% IABP, 16.9% ECMO, 9.1% percutaneous left ventricular assist device, 9.1% surgical ventricular assist devices, and 4.5% other devices.
Results
ECMO as a bridge to heart transplantation was independently associated with a significantly greater risk of severe primary graft dysfunction (PGD).
Adjusted odds ratio for severe PGD with ECMO use was 3.28 (95% confidence interval 1.90–5.66).
Severe PGD was defined according to International Society for Heart and Lung Transplantation criteria.
Multivariable logistic regression was used with multiple imputation for missing data.
Overall ST-MCS (not specifically ECMO) was not associated with severe PGD after adjustment.
Results
Overall ST-MCS use was not independently associated with severe primary graft dysfunction after multivariable adjustment.
The primary outcome of severe PGD was analyzed using multivariable logistic regression models.
Multiple imputation was used to handle missing data.
The finding held across the full cohort of 3800 adult heart transplants.
The lack of association between overall ST-MCS and PGD contrasted with the specific ECMO signal.
Results
One-year mortality after heart transplantation did not differ significantly according to ST-MCS use after multivariable adjustment.
Overall 1-year mortality in the cohort was 11.0%.
Cox proportional hazards models were used to assess 1-year mortality.
Multiple imputation was applied for missing variables.
ST-MCS use as a bridge to transplant did not independently increase 1-year mortality, supporting its use in high-risk patients.
Methods
The study population was derived from a large retrospective multinational registry covering a contemporary transplant era.
The Primary Graft Dysfunction Consortium included 3800 adult heart transplants at 14 centers.
Centers were located in the United States, Canada, and Europe.
The study period spanned 2010 to 2020.
The registry was retrospective in design.
Multivariable logistic regression and Cox models were used as the primary analytical approaches.
Background
Recipient complexity and use of ST-MCS as a bridge to heart transplantation have increased over the study period, reflecting changing clinical practice.
Increasing recipient complexity and donor organ scarcity were cited as drivers of ST-MCS use.
ST-MCS use increased over the decade-long study period from 2010 to 2020.
Geographic variation in device choice was observed, with IABP predominating in the US and ECMO more common in Canada and Europe.
ST-MCS was used in 17.6% of the overall cohort.
What This Means
This research examined whether using temporary heart support machines (called short-term mechanical circulatory support, or ST-MCS) before a heart transplant affects patient outcomes. The study looked at data from nearly 3,800 adult heart transplant patients across 14 hospitals in the US, Canada, and Europe between 2010 and 2020. About 1 in 6 patients received some form of temporary mechanical heart support before their transplant, most commonly an intra-aortic balloon pump. The use of these devices increased over the study period, and the type of device used varied by country.
The most important finding was that, overall, receiving temporary heart support before transplant did not increase the risk of dying within one year or of a serious complication called primary graft dysfunction (where the transplanted heart fails to work properly right after surgery). However, one specific type of device — ECMO (extracorporeal membrane oxygenation), which takes over the work of both the heart and lungs — was linked to more than three times the risk of primary graft dysfunction compared to not using ST-MCS. Despite this higher complication risk, even ECMO use did not significantly increase one-year mortality after adjustment for other factors.
This research suggests that temporary mechanical heart support can be a reasonable bridge to transplantation for very sick patients who might otherwise not survive long enough to receive a donor heart. However, the use of ECMO specifically appears to carry a higher risk of early complications after transplant, which may be important for transplant teams to weigh when selecting which support device to use. The geographic differences in device use highlight that clinical practices vary widely, and further research may help determine the best approach for different patient situations.
Rivas-Lasarte M, Rodenas-Alesina E, Moayedi Y, Truby L, Foroutan F, Henricksen E, et al.. (2026). Short-Term Mechanical Circulatory Support Before Heart Transplantation and Early Outcomes: Insights From the International Primary Graft Dysfunction Consortium.. Journal of cardiac failure. https://doi.org/10.1016/j.cardfail.2026.06.022