Microaxial mechanical circulatory support after orthotopic heart transplantation

Aim: Use of microaxial mechanical circulatory support (MCS) has been reported for severe graft rejection or dysfunction after heart transplantation (HTx). We aimed to assess utilization patterns of microaxial MCS after HTx in adolescents (ages 18 and younger) and adults (ages 19 and older). Methods: Electronic search was performed to identify all relevant studies on post-HTx use of microaxial support in adults and adolescents. A total of 18 studies were selected and patient-level data were extracted for statistical analysis. Results: All patients ( n=23), including adults ( n=15) and adolescents ( n=8), underwent Impella (Abiomed, Danvers, MA) microaxial MCS after HTx. Median age was 36 [IQR 18–56] years (Adults, 52 [37–59]; adolescents, 16 [15–17]). Primary right ventricular graft dysfunction was an indication exclusively seen in the adults 40% (6/15), while acute graft rejection was present in 46.7% (7/15) of adults. Median time after transplant was 9 [0–32] months (Adults, 4 [0–32]; adolescents, 11 [4.5, 45]). Duration of Impella support was comparable between adults and adolescents (5 [2.5–8] vs 6 [5–8] days, p = 0.38). Overall improvement was observed both in median LV ejection fraction (23.5% [11.3–28] to 42% [37.8–47.3], p < 0.01) and cardiac index (1.8 [1.2–2.6] to 3 [2.5–3.1], p < 0.01). Retransplantation was required in four adolescents (50%, 4/8). Survival to discharge was achieved by 60.0% (9/15) of adults and 87.5% (7/8) of adolescents respectively ( p = 0.37). Conclusion: Indications for microaxial MCS appear to vary between adult and adolescent patients. Overall improvement in LVEF and cardiac index was observed, however, with suboptimal survival to discharge.