Long-Term Outcome After Venoarterial Extracorporeal Membrane Oxygenation as Bridge to Left Ventricular Assist Device Preceding Heart Transplantation

Coeckelenbergh, Sean; Valente, F; Mortier, Julien; Engelman, Edgard; Roussoulières, Ana; Oumeiri, Bachar El; Antoine, Martine; Obbergh, Luc Van; Taccone, Fabio Silvio; Eynden, Frédéric Vanden; Stefanidis, Constantin

doi:10.1053/j.jvca.2021.06.035

Cited by 2 publications

(5 citation statements)

References 24 publications

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“…There is little data comparing postoperative complications of BTL and non-BTL patients. Higher rates of bleeding and infections have been reported in BTL patients (11), especially in ECMO patients who presented significantly more bleeding events, cerebrovascular events, and worse survival compared with non-BTL patients (9,20). Conversely, in a retrospective study enrolling 133 INTERMACS-1 LVAD candidates (i.e., 26 ECMO patients and 107 non-ECMO patients), authors reported found no difference in 30 Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Inc. All Rights Reserved.…”

Section: Bridge-to-lvad Strategymentioning

confidence: 97%

Outcome of Temporary Circulatory Support As a Bridge-to-Left Ventricular Assist Device Strategy in Cardiogenic Shock Patients

Bidaut

Flécher

Nesseler

et al. 2022

Critical Care Medicine

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OBJECTIVES: Temporary circulatory support (TCS) as a bridge-to-left ventricular assist device (BTL) in cardiogenic shock patients has been increasing, but limited data exists on this BTL strategy. We aimed at analyzing the outcome of BTL patients in a population of cardiogenic shock patients compared with those without TCS at the time of the left ventricular assist device (LVAD) surgery and identify predictors of postoperative mortality in this specific population. DESIGN: A multicenter retrospective observational study conducted in 19 centers from 2006 to 2016. SETTING: Nineteen French centers. PATIENTS: A total of 329 cardiogenic shock patients at the time of LVAD implantation were analyzed. Patients were divided in three groups: those under TCS at the time of LVAD implantation (n = 173), those with TCS removal before LVAD surgery (n = 24), and those who did not undergo a bridging strategy (n = 152). Primary endpoint was 30-day mortality. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the BTL group, 68 (39.3%), 18 (10.4%), and 15 (8.7%) patients were under venoarterial extracorporeal membrane oxygenation, Impella, and IABP support alone, and 72 patients (20.6%) were under multiple TCS support. BTL patients presented similar 30 days survival compared with the TCS removal and non-BTL groups. However, BTL group had a significantly longer ICU duration stay, with two-fold duration of mechanical ventilation time, but the three groups experienced similar postoperative complications. Multivariate analysis identified three independent predictors of mortality in the BTL group: combined surgery with LVAD, body mass index (BMI), and heart failure (HF) duration. BTL strategy was not an independent predictor of mortality in cardiogenic shock patients who underwent LVAD. CONCLUSIONS: BTL strategy is not associated with a lower survival among cardiogenic shock patients with LVAD implantation. Predictors of mortality are combined surgery with LVAD, higher BMI, and HF duration.

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Section: Bridge-to-lvad Strategymentioning

confidence: 97%

Outcome of Temporary Circulatory Support As a Bridge-to-Left Ventricular Assist Device Strategy in Cardiogenic Shock Patients

Bidaut

Flécher

Nesseler

et al. 2022

Critical Care Medicine

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“…Other conditions that were reported to be risk factors for death are infection, high levels of lactate, and liver dysfunction [5,[6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Outcomes Of Btt With Ecmomentioning

confidence: 99%

“…On the other hand, patients supported with ECMO who could not be weaned and have major risk factors may warrant consideration for an alternative to HT, such as LVAD implantation. In fact, it has been argued that perhaps a strategy of transitioning ECMO supported patients to durable MCS may provide the stabilization required to guarantee better post HT outcomes and more judicious use of transplanted hearts [9,19], but limited and controversial evidence does not permit to generate recommendations.…”

Section: Listing Ecmo Patientsmentioning

confidence: 99%

“…Many institutions advocates favoring the bridge to a durable left ventricular assist device (LVAD) if the function of the right ventricle improves during ECMO support. This strategy was largely adopted in the United States, aiming to consider HTx after the complete recovery of patient clinical conditions [8,9]. However, the results of this so-called "double bridge to HTx" are controversial [9].…”

Section: Introductionmentioning

confidence: 99%

“…This strategy was largely adopted in the United States, aiming to consider HTx after the complete recovery of patient clinical conditions [8,9]. However, the results of this so-called "double bridge to HTx" are controversial [9].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

ECMO as Bridge to Heart Transplantation

Lechiancole¹,

Maiani²,

Vendramin³

et al. 2023

Extracorporeal Membrane Oxygenation Support Therapy

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Extracorporeal membrane oxygenation (ECMO) is increasingly employed to support patients affected by refractory cardiogenic shock. When patients cannot be weaned from ECMO because of severe heart dysfunction, heart transplantation (HTx) or implantation of a durable mechanical circulatory support should be considered. Traditionally, the use of ECMO as a direct bridge to HTx was burdened by high mortality. However, during these last years, the widespread employment of ECMO increased centers’ experience in the management of this device, and new allocation policies provided the highest priority level for ECMO HTx candidates. Therefore, these factors could have mitigated the negative outcomes previously reported. The aim of this chapter is to describe the role of ECMO as a direct bridge to HTx, analyzing results of this strategy, and how to determine candidacy and risk stratification among the severely ill population of patients supported by this mechanical circulatory support.

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Long-Term Outcome After Venoarterial Extracorporeal Membrane Oxygenation as Bridge to Left Ventricular Assist Device Preceding Heart Transplantation

Cited by 2 publications

References 24 publications

Outcome of Temporary Circulatory Support As a Bridge-to-Left Ventricular Assist Device Strategy in Cardiogenic Shock Patients

Outcome of Temporary Circulatory Support As a Bridge-to-Left Ventricular Assist Device Strategy in Cardiogenic Shock Patients

ECMO as Bridge to Heart Transplantation

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