Left ventricular assist device implants in patients on extracorporeal membrane oxygenation: do we need cardiopulmonary bypass?. (11th November 2021)

• Record Type: Journal Article
• Authors: Pappalardo, Federico; Potapov, Evgenij; Loforte, Antonio; Morshuis, Michiel; Schibilsky, David; Zimpfer, Daniel; Riebandt, Julia; Etz, Christian; Attisani, Matteo; Rinaldi, Mauro; Haneya, Assad; Ramjankhan, Faiz; Donker, Dirk; Jorde, Ulrich P; Lewin, Daniel; Wieloch, Radi; Ayala, Rafael; Cremer, Jochen; Bertoldi, Letizia; Borger, Michael; Lichtenberg, Artur; Gummert, Jan; Saeed, Diyar
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 34:Number 4(2022)
• Page Start: 676
• Page End: 682
• Publication Date: 2021-11-11
• Subjects: ECLS -- CPB -- assist device -- outcome -- mechanical circulatory support; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivab311
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: Implanting a durable left ventricular assist device (LVAD) in a patient on extracorporeal life support (ECLS) is challenging. The goal of this study was to compare the results of patients from a European registry who had a durable LVAD implanted with or without transition from ECLS to cardiopulmonary bypass (CPB). METHODS: A total of 531 patients on ECLS support who had an LVAD implant between January 2010 and August 2018 were analysed; after 1:1 propensity score matching, we identified and compared 175 patients in each group. RESULTS: The duration of preoperative ECLS was 7 [standard deviation (SD) 6] vs 7 (SD 6) days in patients with or without CPB ( P = 0.984). The surgical time was longer in the CPB group [285 (SD 72) vs 209 [SD 75] min; P ≤ 0.001). The postoperative chest tube output was comparable [1513 (SD 1311) vs 1390 (SD 1121) ml; P = 0.3]. However, re-exploration for bleeding was necessary in 41% vs 29% of patients with or without CPB ( P = 0.01) and a significantly higher number of packed red blood cells and fresh frozen plasma [8 (SD 8) vs 6 (SD 4) units; P = 0.001 and 6 (SD 7) vs 5 (SD 5) units; P = 0.03] were administered to patients operated on with CPB. A postoperative mechanical right ventricular support device was necessary in 50% vs 41% of patients ( P = 0.08). The stroke rate was not significantly different ( P 0.99). No difference in survival was observed. CONCLUSIONS: Omitting CPB for an LVAD implant in patients on ECLS is safe and results in shorter operating time, less re-exploration for bleeding and fewer blood products. However, no survival benefit is observed. Abstract : Continuous flow left ventricular assist devices (LVADs) have revolutionized the outcome of patients suffering from refractory heart failure [1, 2]; yet, this therapy is also applied 'in extremis' for patients with cardiogenic shock and temporary circulatory support.