Cardiac Transplantation and ECMO: A Synergistic Approach

Cardiac transplantation is the gold standard treatment for end-stage heart failure, offering definitive therapy for patients unresponsive to advanced medical management. Extracorporeal membrane oxygenation (ECMO) plays a pivotal role in critically supporting ill patients as a bridge to transplant, providing temporary hemodynamic and respiratory stabilization. ECMO is particularly effective in patients with cardiogenic shock or multi-organ dysfunction, improving tissue oxygenation and perfusion while awaiting a suitable donor organ. Despite its life-saving potential, ECMO is associated with significant risks, including hemorrhage, thromboembolism, infection, and prolonged organ dysfunction. Careful candidate selection, meticulous anticoagulation management, and a multidisciplinary team approach are essential to mitigate these complications and optimize outcomes. Emerging evidence highlights the potential of ECMO to expand the transplant candidate pool and improve survival rates. As an integral part of advanced heart failure treatment, ECMO continues to evolve, offering hope to patients in critical need of a heart transplant. Refractory cardiogenic shock has a high mortality rate despite optimal medical management. Cardiogenic shock is one of the main causes of in-hospital mortality, with significant variations in incidence depending on access to advanced therapies such as the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO), which is a vitally important therapy. Its implementation as part of the treatment of patients with refractory cardiogenic shock is necessary.