Impact of preoperative extracorporeal life support on left ventricular assist device outcomes: A comparative study

Abstract

Background: To investigate whether preoperative short-term extracorporeal life support therapy in patients undergoing continuous-flow left ventricular assist device implantation has an impact on the outcome regarding survival and adverse events. Methods: Between January 2011 and May 2018, 100 consecutive patients received HeartMate II, HeartWare, or HeartMate III for end-stage heart failure. Mean age was 64.2 ± 10.3 years. Three patient groups were identified: without preoperative extracorporeal life support (non-extracorporeal life support group, n = 80), with preoperative extracorporeal life support due to postcardiotomy shock after conventional cardiac surgery (postcardiotomy shock group, n = 9), and with preoperative extracorporeal life support without previous surgery (non-postcardiotomy shock group, n = 11). The primary endpoint was overall survival after device implantation. Secondary endpoints were adverse events during the follow-up period. Results: Survival was significantly different between the groups (p < 0.05): 30-day, 6-month, and 1-year survival rates were 85%, 68%, and 61% for non-extracorporeal life support group; 44%, 22%, and 22% for postcardiotomy shock group; and 45%, 27%, and 24% for non-postcardiotomy shock group, respectively. Furthermore, in both extracorporeal life support groups (postcardiotomy shock and non-postcardiotomy shock), there were a higher incidence (p < 0.05) of postoperative right heart failure (30% vs 66.7% vs 54.5%), acute renal failure requiring dialysis (20% vs 77.8% vs 54.5%), and respiratory failure (31.3% vs 88.9% vs 81.8%). Conclusion: Continuous-flow left ventricular assist device implantation with prior extracorporeal life support appears to have a worse outcome regarding survival, right heart failure, renal and respiratory dysfunction (p < 0.05). Future studies have to be done to evaluate the outcome after extracorporeal life support bridge pre-left ventricular assist device, especially as ultima ratio in postcardiotomy shock patients.

A real‐life experience with HeartMate III

“…A recent report from Germany found that redo sternotomy increased the risk of mortality, blood product transfusion, hepatic and renal dysfunction and ischaemic stroke after VAD implant compared to patients with no previous sternotomy (9). In a separate publication, the same authors found preoperative ECMO to be associated with worse survival, increased right heart failure, respiratory failure and renal failure (10). In our series, five (15%) patients were redo sternotomies, and six (18%) were…”

“…Those reports excluded patients requiring concomitant procedures, mechanical right sided support, pre VAD mechanical support such as ECMO and redo sternotomies. All of these conditions are well known to increase mortality and morbidity in VAD recipients (9,10). A recent report from Germany found that redo sternotomy increased the risk of mortality, blood product transfusion, hepatic and renal dysfunction and ischaemic stroke after VAD implant compared to patients with no previous sternotomy (9).…”

Venoarterial extracorporeal life support

“…Our experience with the ECPELLA concept was previously published from our group. 3 Also, we described different bridging strategies 4 and modern minimally invasive techniques of ECLS implantation 5 in our numerous previously published works.…”

Clinical outcomes of venoarterial extracorporeal life support in 462 patients: Single‐center experience

“…The use of venovenous (VV)‐ECLS for isolated pulmonary support has been gaining ground . ECLS is being increasingly used as a bridge for decision, recovery, durable mechanical circulatory support, or heart/lung transplantation …”