• Sean Coeckelenbergh, Federica Valente, Julien Mortier, Edgard Engelman, Ana Roussoulières, Bachar El Oumeiri, Martine Antoine, Luc Van Obbergh, Fabio Silvio Taccone, Frédéric Vanden Eynden, and Constantin Stefanidis.
• Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. Electronic address: sean.coeckelenbergh@ulb.be.
• J. Cardiothorac. Vasc. Anesth. 2022 Jun 1; 36 (6): 1694-1702.

ObjectivesTo determine if venoarterial extracorporeal membrane oxygenation (VA ECMO) as a bridge to left ventricular assist device (LVAD) in heart transplant (HT) candidates (ie, double bridge to HT) was associated with increased morbidity and mortality when compared to LVAD bridging to HT (ie, single bridge to HT).DesignA retrospective analysis of patients undergoing LVAD support from 2011 to 2020. A Kaplan-Meier survival curve and Cox-Mantel hazard ratios (HR) were calculated during LVAD support and after HT. Postoperative complications were collected.SettingUniversity Hospital Erasme.ParticipantsHT candidates requiring LVAD.InterventionsVA ECMO bridging to LVAD (ECMO-LVAD group [n = 24]) versus LVAD (LVAD group [n = 64]).Measurements And Main ResultsEighty-eight patients underwent HeartWare LVAD (HVAD, Medtronic) placement. Survival to hospital discharge and during the entire study period were lower in the ECMO-LVAD group (66.7% v 92.2%; p = 0.0027, and 37.5% v 62.5%; p = 0.035, respectively). Overall HR of death was 2.46 (95% confidence interval [CI]: 1.13-5.37; p = 0.005) in the ECMO-LVAD group and remained elevated throughout their time on LVAD support (HR 3.24 [95% CI: 1.15-9.14]; p = 0.0036). However, in patients who underwent HT (n = 50), mortality was similar between groups (HR 1.33 [95% CI: 0.33-5.31]; p = 0.66). Postoperative complications were more frequent in the ECMO-LVAD group (infection = 83.3% v 51.6%, p = 0.007; renal replacement therapy = 45.8% v 9.4%, p = 0.0001; post-LVAD ECMO = 25.0% v 1.6%; p = 0.0003).ConclusionsVA ECMO as a bridge to LVAD support before HT was associated with increased morbidity and mortality during LVAD support. However, in patients who underwent HT, outcomes were similar regardless of VA ECMO bridging.Copyright © 2021 Elsevier Inc. All rights reserved.

16 keywords...

hide…