• Gonzalo Barge-Caballero, María A Castel-Lavilla, Luis Almenar-Bonet, Iris P Garrido-Bravo, Juan F Delgado, Diego Rangel-Sousa, José González-Costello, Javier Segovia-Cubero, Marta Farrero-Torres, José Luis Lambert-Rodríguez, María G Crespo-Leiro, Daniela Hervás-Sotomayor, Ana Portolés-Ocampo, Manuel Martínez-Sellés, Luis De la Fuente-Galán, Gregorio Rábago-Juan-Aracil, Francisco González-Vílchez, Sonia Mirabet-Pérez, Javier Muñiz, and Eduardo Barge-Caballero.
• Complejo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
• Interact Cardiovasc Thorac Surg. 2019 Nov 1; 29 (5): 670-677.

ObjectivesTo investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT).MethodsWe studied 169 patients who were listed for urgent HT under VA-ECMO support at 16 Spanish institutions from 2010 to 2015. The clinical outcomes of patients under simultaneous IABP support (n = 73) were compared to a control group of patients without IABP support (n = 96).ResultsThere were no statistically significant differences between the IABP and control groups with regard to the cumulative rates of transplantation (71.2% vs 81.2%, P = 0.17), death during VA-ECMO support (20.6% vs 14.6%, P = 0.31), transition to a different mechanical circulatory support device (5.5% vs 5.2%, P = 0.94) or weaning from VA-ECMO support due to recovery (2.7% vs 0%, P = 0.10). There was a higher incidence of bleeding events in the IABP group (45.2% vs 25%, P = 0.006; adjusted odds ratio 2.18, 95% confidence interval 1.02-4.67). In-hospital postoperative mortality after HT was 34.6% in the IABP group and 32.5% in the control group (P = 0.80). One-year survival after listing for urgent HT was 53.3% in the IABP group and 52.2% in the control group (log rank P = 0.75). Multivariate adjustment for potential confounders did not change this result (adjusted hazard ratio 0.94, 95% confidence interval 0.56-1.58).ConclusionsIn our study, simultaneous IABP therapy in transplant candidates under VA-ECMO support did not significantly reduce morbidity or mortality.© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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