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Role of percutaneous veno-arterial extracorporeal membrane oxygenation as bridge to left ventricular assist device

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  • Artificial Heart (Clinical)
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Abstract

Percutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides emergency circulatory support for cardiogenic shock patients and is used as a bridge to a left ventricular assist device (LVAD). The purpose of this study was to determine risk factors for LVAD implantation in patients who required percutaneous VA-ECMO as a bridge to long-term LVAD. We retrospectively investigated 32 consecutive LVAD patients who required percutaneous VA-ECMO as a bridge to long-term LVAD. Twenty-nine patients (91%) were intubated, and their serum creatinine and total bilirubin levels before LVAD implantation were 2.1 ± 2.0 and 3.7 ± 3.7 mg/dl, respectively. Patients were supported by LVAD for 495 ± 393 days, during which 15 died, 6 recovered native cardiac functions and LVAD was explanted, and 11 underwent heart transplantation. Multivariate logistic regression analysis revealed that a preoperative left ventricular end-diastolic diameter (LVDd) ≤54 mm was a significant predictor of 90-day mortality after LVAD implantation (OR 13.64; 95% CI 1.081–172.0; p = 0.0433) and freedom from death during LVAD support was significantly worse in patients with an LVDd ≤54 mm. Furthermore, preoperative LVDd was positively correlated with postoperative right ventricular stroke work index (r = 0.739, p < 0.0001) and patients with an LVDd ≤54 mm had significantly worse postoperative right ventricular, renal, and hepatic functions. We demonstrated that percutaneous VA-ECMO could be utilized as a bridge to long-term LVAD in selected patients. Our results suggest that preoperative LVDd is a useful predictor of mortality and right ventricular function after LVAD implantation in patients requiring VA-ECMO, in whom assessment of right ventricular function is challenging.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan

    Koichi Toda & Tomoyuki Fujita

  2. Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan

    Osamu Seguchi, Masanobu Yanase & Takeshi Nakatani

  3. 2-2, Yamada-Oka, Suita, Osaka, 565-8565, Japan

    Koichi Toda

Authors
  1. Koichi Toda
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  2. Tomoyuki Fujita
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  3. Osamu Seguchi
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  4. Masanobu Yanase
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  5. Takeshi Nakatani
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Correspondence to Koichi Toda.

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The authors declare no conflict of interest.

Additional information

A part of the manuscript was read at the 48th Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, January 28 to February 1, 2012.

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Toda, K., Fujita, T., Seguchi, O. et al. Role of percutaneous veno-arterial extracorporeal membrane oxygenation as bridge to left ventricular assist device. J Artif Organs 21, 39–45 (2018). https://doi.org/10.1007/s10047-017-0984-3

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  • DOI: https://doi.org/10.1007/s10047-017-0984-3

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