• JACC. Heart failure · Dec 2018

    Unloading of the Left Ventricle During Venoarterial Extracorporeal Membrane Oxygenation Therapy in Cardiogenic Shock.

    • Benedikt Schrage, Daniel Burkhoff, Nicole Rübsamen, BecherPeter MoritzPMDepartment of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany., Michael Schwarzl, Alexander Bernhardt, Hanno Grahn, Edith Lubos, Gerold Söffker, Peter Clemmensen, Hermann Reichenspurner, Stefan Blankenberg, and Dirk Westermann.
    • Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research, Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.
    • JACC Heart Fail. 2018 Dec 1; 6 (12): 1035-1043.

    ObjectivesThis report relates the authors' ongoing experience with percutaneous left ventricular (LV) unloading by using a transaortic LV assist device in combination with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and provides an in-depth analysis of the hemodynamic benefit of this approach.BackgroundVA-ECMO is increasingly used in cases of severe cardiogenic shock. However, increase in afterload with subsequent LV overload is a major drawback of VA-ECMO.MethodsConsecutive patients were treated with a transaortic LV assist device in addition to VA-ECMO for cardiogenic shock. The primary endpoint was 30-day all-cause mortality. Additional endpoints included weaning from VA-ECMO and safety endpoints.ResultsBetween September 2013 and January 2018, 106 patients were treated with percutaneous LV unloading, using a transaortic LV assist device in combination with VA-ECMO. Successful weaning from VA-ECMO support was achieved in 51.9% of all patients. In the overall cohort, survival at day 30 was 35.8%, which was higher than predicted by the SAVE score (20%) or by the SAPS-II score (6.9%). Right heart catheterization indicated a marked decrease of PCWP after addition of the device to VA-ECMO.ConclusionsThe strategy of percutaneous LV unloading using a transaortic LV assist device in combination with VA-ECMO improved outcome in an all-comers cohort compared to established risk scores. A prospective, randomized study is needed to further investigate this approach.Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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