Rescue extracorporeal life support as a bridge to durable left ventricular assist device

Abstract

Background: The ideal timing of a durable assist device implantation in patients with end-stage heart failure presenting with INTERMACS profile I is still controversial. The data on extracorporeal life support (ECLS) bridge to durable left ventricular assist device (LVAD) in these patients is limited. Materials and methods: We retrospectively analyzed the outcomes of 35 patients in acute cardiogenic shock (CS) who, between December 2013 and September 2020, were bridged with ECLS to durable LVAD. The mean age was 52.3 ± 12.0 years. The primary endpoints of this study were in-hospital, 30-day, 6-month, and 1-year mortality. The secondary endpoint was the development of any postoperative adverse events and other characteristics during the follow-up period. We also assessed the impact of the rescue ECLS on the recovery of the end-organ function. Results: In-hospital, 30-day, 6-month, and 1-year survival was 65.6%, 75.9%, 69.2%, and 62.7% respectively. The median time on ECLS was 7 days (IQR 5.0–13.0). We observed a high incidence of a severe right heart failure (22.9%), acute kidney injury on dialysis (68.6%), and respiratory failure (77.1%). Bridge with ECLS provided a significant recovery of liver and kidney function prior to durable LVAD implantation. Conclusion: The concept of bridging patients presenting in end-stage heart failure and cardiogenic shock with ECLS prior to durable LVAD implantation is a feasible method to ensure acceptable survival rates and significant recovery of the end-organ function.

Perioperative Outcomes in Patients With Failing Single-Ventricle Physiology Undergoing Ventricular Assist Device Placement: A Single Institutional Experience

“…3 The data on ECLS as a bridge to VAD is limited, with adult studies observing a high incidence of acute kidney injury on dialysis (68.6%), and respiratory failure (77%) in a majority of patients with acute cardiogenic shock. 27 The intraoperative and post-operative coagulopathy observed in our data may correlate to similar clinical manifestations of end-organ damage following ECLS that potentially predispose patients to an increased need of perioperative blood products and increased bleeding in the postoperative period following VAD placement.…”

Temporary extracorporeal life support: single-centre experience with a new concept

“…LVAD implantation in Interagency Registry of Mechanically Assisted Circulatory Support 1/2 patients is known to have a high postoperative mortality rate. While single-centre studies have reported 30-day survival rates ranging from 60% to 85%, there are currently no robust data available on the survival benefits of bridging patients on va-ECMO to a durable LVAD [ 21 , 22 ]. Use of va-ECMO helps stabilize haemodynamics and end-organ perfusion during the acute phase of CS.…”