1
|
Schurr JW, Ambrosi L, Fitzgerald J, Bermudez C, Genuardi MV, Brahier M, Elliot T, McGowan K, Zaaqoq A, Laskar S, Pope SM, Givertz MM, Mallidi H, Sylvester KW, Seifert FC, McLarty AJ. Multicenter evaluation of left ventricular assist device implantation with or without ECMO bridge in cardiogenic shock. Artif Organs 2024; 48:921-931. [PMID: 38459758 DOI: 10.1111/aor.14740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/26/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND The efficacy of extracorporeal membrane oxygenation (ECMO) as a bridge to left ventricular assist device (LVAD) remains unclear, and recipients of the more contemporary HeartMate 3 (HM3) LVAD are not well represented in previous studies. We therefore undertook a multicenter, retrospective study of this population. METHODS AND RESULTS INTERMACS 1 LVAD recipients from five U.S. centers were included. In-hospital and one-year outcomes were recorded. The primary outcome was the overall mortality hazard comparing ECMO versus non-ECMO patients by propensity-weighted survival analysis. Secondary outcomes included survival by LVAD type, as well as postoperative and one-year outcomes. One hundred and twenty-seven patients were included; 24 received ECMO as a bridge to LVAD. Mortality was higher in patients bridged with ECMO in the primary analysis (HR 3.22 [95%CI 1.06-9.77], p = 0.039). Right ventricular assist device was more common in the ECMO group (ECMO: 54.2% vs non-ECMO: 11.7%, p < 0.001). Ischemic stroke was higher at one year in the ECMO group (ECMO: 25.0% vs non-ECMO: 4.9%, p = 0.006). Among the study cohort, one-year mortality was lower in HM3 than in HeartMate II (HMII) or HeartWare HVAD (10.5% vs 46.9% vs 31.6%, respectively; p < 0.001) recipients. Pump thrombosis at one year was lower in HM3 than in HMII or HVAD (1.8% vs 16.1% vs 16.2%, respectively; p = 0.026) recipients. CONCLUSIONS Higher mortality was observed with ECMO as a bridge to LVAD, likely due to higher acuity illness, yet acceptable one-year survival was seen compared with historical rates. The receipt of the HM3 was associated with improved survival compared with older generation devices.
Collapse
Affiliation(s)
- James W Schurr
- Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lara Ambrosi
- Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jillian Fitzgerald
- Stony Brook University Hospital, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Christian Bermudez
- Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael V Genuardi
- Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mark Brahier
- Medstar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, USA
| | - Tonya Elliot
- Medstar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, USA
| | - Kevin McGowan
- Medstar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, USA
| | - Akram Zaaqoq
- UVA Health, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Sonjoy Laskar
- Emory University Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stuart M Pope
- Emory University Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael M Givertz
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hari Mallidi
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katelyn W Sylvester
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank C Seifert
- Stony Brook University Hospital, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Allison J McLarty
- Stony Brook University Hospital, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| |
Collapse
|
3
|
Jawad K, Nozdrzykowski M, Borger MA, Saeed D. Less Invasive Assist Device Implantation in Patients with History of Previous Cardiac Procedures. Ann Thorac Surg 2022; 114:383-386. [PMID: 35477017 DOI: 10.1016/j.athoracsur.2022.03.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/02/2022] [Accepted: 03/28/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Khalil Jawad
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | | | - Michael A Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Diyar Saeed
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
| |
Collapse
|
4
|
Bernhardt AM, Schrage B, Schroeder I, Trummer G, Westermann D, Reichenspurner H. Extracorporeal membrane oxygenation. DEUTSCHES ÄRZTEBLATT INTERNATIONAL 2022; 119:235-244. [PMID: 35037618 PMCID: PMC9342119 DOI: 10.3238/arztebl.m2022.0068] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/08/2021] [Accepted: 11/25/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Veno-venous extracorporeal membrane oxygenation (VV-ECMO) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), also known as extracorporeal life support (ECLS), can both be used to treat patients with acute pulmonary or cardiovascular failure. METHODS This review is based on publications retrieved by a selective search in PubMed on the topics of cardiogenic shock and acute pulmonary failure, also known as the acute respiratory distress syndrome (ARDS), as well as on ECMO. Attention was given chiefly to randomized, controlled trials and guidelines. RESULTS Initial findings from prospective, randomized trials of VV-ECMO are now available. Trials of ECLS therapy are now in progress or planned. A meta-analysis of two randomized, controlled trials of VV-ECMO for ARDS revealed more frequent survival 90 days after randomization among patients treated with VV-ECMO, compared to the control groups (36% vs. 48%; RR = 0.75 [95% confidence interval 0.6; 0.94]). For selected patients, after evaluation of the benefit-risk profile, VV-ECMO is a good treatment method for severe pulmonary failure, and ECLS for cardiogenic shock and resuscitation. The goal is to secure the circulation so that native heart function can be stabilized in the patient's further course or a permanent left-heart support system can be implanted, or else to support lung function until recovery. CONCLUSION ECMO is a valid option in selected patients when conservative treatment has failed.
Collapse
|
5
|
Lewin D, Nersesian G, Roehrich L, Mueller M, Mulzer J, Stein J, Kukucka M, Starck C, Schoenrath F, Falk V, Ott S, Potapov EV. Impact of left ventricular inspection employing cardiopulmonary bypass on outcome after implantation of left ventricular assist device. Artif Organs 2021; 46:908-921. [PMID: 34904259 DOI: 10.1111/aor.14145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/18/2021] [Accepted: 12/06/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cardiopulmonary bypass (CPB) during left ventricular assist device (LVAD) implantation provides circulatory support and allows for safe inspection of the left ventricle (LV), whereas circulatory support by veno-arterial extracorporeal life support (va-ECLS) or off-pump implantation may reduce postoperative bleeding and inflammatory response. METHODS Retrospective analysis of 616 consecutive adult patients who received an LVAD via median sternotomy between January 1, 2015 and December 31, 2019. All patients undergoing concomitant intracardiac procedures other than closure of persistent foramen ovale or atrial septal defect and redo surgeries were excluded from the analysis. The remaining patients (n = 222) were divided into two groups and 1:1 propensity score-matched regarding preoperative parameters: patients who underwent LVAD implantation with LV inspection employing CPB (CPB group, n = 62) and without LV inspection on va-ECLS or off-pump (non-CPB group, n = 62). RESULTS The groups were well balanced with regard to preoperative baseline characteristics (standard difference <0.1). Patients in the CPB group required more blood transfusions (median 2 vs. 0 units, p = 0.031) during surgery and in the first 24 h afterwards. The median intensive care unit stay was longer in the CPB group (18 vs. 11 days, p = 0.021). The CPB group showed an absence of perioperative stroke and a smaller number of events per patient-year for postoperative ischemic stroke (0.02 vs. 0.12, p = 0.003). 30-day survival (87% vs. 87.1%) and 1-year survival (80.3% vs. 74%) were similar in both groups (p = 0.78). CONCLUSION Visual LV inspection on CPB may reduce the risk of postoperative ischemic stroke. Despite the negative effects of employing CPB in lieu of other intraoperative strategies, survival was similar in both groups.
Collapse
Affiliation(s)
- Daniel Lewin
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Gaik Nersesian
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Luise Roehrich
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,German Heart Foundation, Frankfurt am Main, Germany
| | - Marcus Mueller
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Johanna Mulzer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Julia Stein
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Marian Kukucka
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Berlin, Germany
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Translational Cardiovascular Technologies, Department of Health Sciences and Technology, Institute of Translational Medicine, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Sascha Ott
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Berlin, Germany
| | - Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| |
Collapse
|
6
|
Hanke JS, Dogan G, Shrestha M, Haverich A, Schmitto JD. Innovations in implantation techniques of ventricular assist devices. JTCVS OPEN 2021; 8:28-32. [PMID: 36004096 PMCID: PMC9390346 DOI: 10.1016/j.xjon.2021.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/27/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Jasmin S. Hanke
- Address for reprints: Jasmin S. Hanke, MD, Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str 1, 30625 Hannover, Germany.
| | | | | | | | | |
Collapse
|