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Ardito V, Sarucanian L, Rognoni C, Pieri M, Scandroglio AM, Tarricone R. Impella Versus VA-ECMO for Patients with Cardiogenic Shock: Comprehensive Systematic Literature Review and Meta-Analyses. J Cardiovasc Dev Dis 2023; 10:jcdd10040158. [PMID: 37103037 PMCID: PMC10142129 DOI: 10.3390/jcdd10040158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 04/28/2023] Open
Abstract
Impella and VA-ECMO are two possible therapeutic courses for the treatment of patients with cardiogenic shock (CS). The study aims to perform a systematic literature review and meta-analyses of a comprehensive set of clinical and socio-economic outcomes observed when using Impella or VA-ECMO with patients under CS. A systematic literature review was performed in Medline, and Web of Science databases on 21 February 2022. Nonoverlapping studies with adult patients supported for CS with Impella or VA-ECMO were searched. Study designs including RCTs, observational studies, and economic evaluations were considered. Data on patient characteristics, type of support, and outcomes were extracted. Additionally, meta-analyses were performed on the most relevant and recurring outcomes, and results shown using forest plots. A total of 102 studies were included, 57% on Impella, 43% on VA-ECMO. The most common outcomes investigated were mortality/survival, duration of support, and bleeding. Ischemic stroke was lower in patients treated with Impella compared to the VA-ECMO population, with statistically significant difference. Socio-economic outcomes including quality of life or resource use were not reported in any study. The study highlighted areas where further data collection is needed to clarify the value of complex, new technologies in the treatment of CS that will enable comparative assessments focusing both on the health impact on patient outcomes and on the financial burden for government budgets. Future studies need to fill the gap to comply with recent regulatory updates at the European and national levels.
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Affiliation(s)
- Vittoria Ardito
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
| | - Lilit Sarucanian
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
| | - Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
- Department of Social and Political Science, Bocconi University, 20136 Milan, Italy
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Reza J, Mila A, Ledzian B, Sun J, Silvestry S. Incremental cost-effectiveness of extracorporeal membranous oxygenation as a bridge to cardiac transplant or left ventricular assist device placement in patients with refractory cardiogenic shock. JTCVS OPEN 2022; 11:132-145. [PMID: 36172402 PMCID: PMC9510879 DOI: 10.1016/j.xjon.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/26/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
Abstract
Objective Emerging literature has described using venoarterial extracorporeal membranous oxygenation (ECMO) as a bridge to transplant or left ventricular assist device (LVAD) placement. We sought to identify the incremental cost-effectiveness ratio (ICER) of ECMO used as a bridge to cardiac transplant or LVAD. Methods Patients with refractory cardiogenic shock who received venoarterial ECMO and were bridged to either cardiac transplant (n = 7) or a HeartMate 3 LVAD (n = 6) placement were included. Markov modeling was used, comparing ECMO bridging with non–ECMO-bridged patients. Cohorts entered the model alive and at every 1-year cycle, were exposed to risk of death, and ran forward for 20 years after transplant or LVAD. Results Patients bridged with ECMO to cardiac transplant were stratified as group 1 whereas those bridged with ECMO to LVAD were stratified as group 2. The average ECMO run was 3 days in group 1 versus 11 days in group 2. Among group 1 patients, the ICER was $246,629 but was paired with a longer life expectancy. The ICER of group 2 patients was –$107,088 and was not paired with a longer life expectancy. The average inpatient cost for group 1 was found to be $636,023 versus $769,471 for group 2 patients. The average inpatient costs for patients not bridged to ECMO who received cardiac transplant or LVAD was $538,928 and $325,242, respectively. Conclusions Using ECMO to bridge to transplant or LVAD placement is not cost effective. However, patients bridged to transplant are paired with longer life expectancy in contrast to patients bridged to LVAD.
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Affiliation(s)
- Joseph Reza
- General Surgery Residency Program, AdventHealth Orlando, Orlando, Fla
- Address for reprints: Joseph Reza, MD, 3401 N. Broad St. C501. Philadelphia, PA 19140.
| | - Ashley Mila
- General Surgery Residency Program, AdventHealth Orlando, Orlando, Fla
| | - Bradford Ledzian
- AdventHealth Transplant Institute, Thoracic Transplant and Cardiovascular Surgery, AdventHealth Orlando, Orlando, Fla
| | - Jingwei Sun
- Center for Academic Research, AdventHealth Orlando, Orlando, Fla
| | - Scott Silvestry
- AdventHealth Transplant Institute, Thoracic Transplant and Cardiovascular Surgery, AdventHealth Orlando, Orlando, Fla
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Predictors of mortality following extracorporeal membrane oxygenation support in an unselected, critically ill patient population. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:290-297. [PMID: 34819965 PMCID: PMC8596723 DOI: 10.5114/aic.2021.109149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Mechanical circulatory support (MCS) has been established as a means of augmenting circulation in patients with critically decreased systolic function due to a variety of underlying clinical reasons. Different methods of MCS may be used, with the venous-arterial extracorporeal membrane oxygenation system (VA-ECMO) being one of the most utilized devices in everyday care. Aim To determine independent predictors influencing mortality outcomes following VA-ECMO therapy in a large, unselected, adult, critically ill patient population in cardiogenic shock (CS). Material and methods Data on 235 consecutive, real-world VA-ECMO treatments were assessed. Analysis was conducted for all subjects requiring MCS with the VA-ECMO as the first instalment, regardless of underlying cause or eventual upgrade. All potential clinical factors influencing mortality were examined and evaluated. Results Overall mortality was ~66% at median 28 days follow-up and significantly depended upon pH < 7.3 (HR = 3.56; p < 0.001), and age ≥ 65 years (HR = 1.96; p = 0.001). Acute coronary syndrome (ACS) as an indication for VA-ECMO displayed a nearly significant value (HR = 1.44; p = 0.07). Heart transplant (hTX) primary graft failure as an indication for the VA-ECMO displayed a clearly favorable outcome (HR = 0.51, p = 0.025); all data based on multivariate Cox regression analysis. Conclusions Mortality in patients requiring VA-ECMO remains high. We conclude that only decreased pH values and advanced age clearly influence mortality in this MCS scenario. ACS also bodes unfavorably, whereas hTX as an indication clearly shows better survival.
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Anselmi A, Galand V, Vincentelli A, Boule S, Dambrin C, Delmas C, Barandon L, Pernot M, Kindo M, Tam HM, Gaudard P, Rouviere P, Senage T, Michel M, Boignard A, Chavanon O, Verdonk C, Para M, Gariboldi V, Pelce E, Pozzi M, Obadia JF, Anselme F, Litzler PY, Babatasi G, Belin A, Garnier F, Bielefeld M, Guihaire J, Kloeckner M, Radu C, Lellouche N, Bourguignon T, Genet T, D'Ostrevy N, Duband B, Jouan J, Bories MC, Vanhuyse F, Blangy H, Colas F, Verhoye JP, Martins R, Flecher E. Current results of left ventricular assist device therapy in France: the ASSIST-ICD registry. Eur J Cardiothorac Surg 2021; 58:112-120. [PMID: 32298439 DOI: 10.1093/ejcts/ezaa055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Our goal was to provide a picture of left ventricular assist device (LVAD) activity in France between 2007 and 2016 based on the multicentric ASSIST-ICD registry. METHODS We retrospectively collected 136 variables including in-hospital data, follow-up survival rates and adverse events from 671 LVAD recipients at 20 out of 24 LVAD implant centres in France. The average follow-up time was 1.2 years (standard deviation: 1.4); the total follow-up time was 807.5 patient-years. RESULTS The included devices were the HeartMate II®, HeartWare LVAS® or Jarvik 2000®. The overall likelihood of being alive while on LVAD support or having a transplant (primary end point) at 1, 2, 3 and 5 years postimplantation was 65.2%, 59.7%, 55.9% and 47.7%, respectively, given a cumulative incidence of 29.2% of receiving a transplant at year 5. At implantation, 21.5% of patients were on extracorporeal life support. The overall rate of cardiogenic shock at implantation was 53%. The major complications were driveline infection (26.1%), pump pocket or cannula infection (12.6%), LVAD thrombosis (12.2%), ischaemic (12.8%) or haemorrhagic stroke (5.4%; all strokes 18.2%), non-cerebral haemorrhage (9.1%) and LVAD exchange (5.2%). The primary end point (survival) was stratified by age at surgery and by the type of device used, with inference from baseline profiles. The primary end point combined with an absence of complications (secondary end point) was also stratified by device type. CONCLUSIONS The ASSIST-ICD registry provides a real-life picture of LVAD use in 20 of the 24 implant centres in France. Despite older average age and a higher proportion of patients chosen for destination therapy, survival rates improved compared to those in previous national registry results. This LVAD registry contrasts with other international registries because patients with implants have more severe disease, and the national policy for graft attribution is distinct. We recommend referring patients for LVAD earlier and suggest a discussion of the optimal timing of a transplant for bridged patients (more dismal results after the second year of support?).
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Affiliation(s)
- Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Vincent Galand
- Division of Cardiology, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - André Vincentelli
- Department of Cardiac Surgery, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - Stéphane Boule
- Department of Cardiology, CHU Lille, Institut Coeur-Poumons, Lille, France
| | - Camille Dambrin
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Clément Delmas
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Laurent Barandon
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Mathieu Pernot
- Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France
| | - Michel Kindo
- Département de Chirurgie Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hoang Minh Tam
- Département de Chirurgie Cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, PhyMedExp, University of Montpellier, INSERM, CNRS, CHU Montpellier, Montpellier, France
| | - Philippe Rouviere
- Department of Cardiac Surgery, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Thomas Senage
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, Nantes, France
| | - Magali Michel
- Department of Cardiology and Heart Transplantation Unit, CHU Nantes, Nantes, France
| | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Olivier Chavanon
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Constance Verdonk
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
| | - Marylou Para
- Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Edeline Pelce
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Frederic Anselme
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Pierre-Yves Litzler
- Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France
| | - Gerard Babatasi
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, Caen, France
| | - Annette Belin
- Department of Cardiology and Cardiac Surgery, University of Caen and University Hospital of Caen, Caen, France
| | - Fabien Garnier
- Department of Cardiology and Cardiac Surgery, University Hospital François Mitterrand, Dijon, France
| | - Marie Bielefeld
- Department of Cardiology and Cardiac Surgery, University Hospital François Mitterrand, Dijon, France
| | - Julien Guihaire
- Department of Cardiac Surgery, Research and Innovation Unit, INSERM U999, Marie Lannelongue Hospital, Paris Sud University, Le Plessis Robinson, France
| | - Martin Kloeckner
- Department of Cardiac Surgery, Marie Lannelongue Hospital, Paris Sud University, Le Plessis Robinson, France
| | - Costin Radu
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | - Nicolas Lellouche
- Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France
| | | | - Thibaud Genet
- Department of Cardiology, Tours University Hospital, Tours, France
| | - Nicolas D'Ostrevy
- Cardiac Surgery and Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Benjamin Duband
- Cardiac Surgery and Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jerome Jouan
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | | | - Fabrice Vanhuyse
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, CHU de Nancy, Hopital de Brabois, Nancy, France
| | - Fabrice Colas
- Division of Thoracic and Cardiovascular Surgery, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Jean-Philippe Verhoye
- Division of Thoracic and Cardiovascular Surgery, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Raphael Martins
- Division of Cardiology, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
| | - Erwan Flecher
- Division of Thoracic and Cardiovascular Surgery, Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
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Lee H, Sung K, Suh GY, Chung CR, Yang JH, Jeon K, Carriere KC, Ahn JH, Cho YH. Outcomes of transported and in-house patients on extracorporeal life support: a propensity score-matching study. Eur J Cardiothorac Surg 2021; 57:317-324. [PMID: 31504394 DOI: 10.1093/ejcts/ezz227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/08/2019] [Accepted: 07/21/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Patients on extracorporeal life support (ECLS), like other critically ill patients, are transported to other institutions for various reasons. However, little has been reported concerning the characteristics and clinical outcomes of transported patients compared with those of in-house patients. METHODS A total of 281 adult patients received ECLS between January 2014 and August 2016. Patients who underwent cannulation at another institution by our team were excluded. Patients were divided into 2 groups: transported group (N = 46) and in-house group (N = 235). All 46 patients were safely transported without serious adverse events. The mean travel distance was 206±140 km, with a mean travel time of 78 ± 57 min. Following propensity score matching, 44 transported patients were matched to 148 in-house patients. RESULTS In the matched population, the mean age was 48 ± 13 years in the transported group and 49 ± 17 years in the in-house group (P = 0.70). The ECLS type (venoarterial/venovenous) comprised 35/9 (79.5/20.5%) in the transported group and 119/29 (80.4/19.6%) in the in-house group (P = 0.93). Seventeen (38.6%) extracorporeal cardiopulmonary resuscitations were performed in the transported group and 59 (39.9%) were performed in the in-house group (P = 0.91). The incidence of limb ischaemia and acute kidney injury was higher in the transported group (P = 0.007 and P = 0.001, respectively). However, the rate of survival to discharge did not differ between the groups (63.6% in the transported group vs 64.2% in the in-house group, P = 0.94) and there was no difference in overall mortality (P = 0.99). CONCLUSIONS Although transported patients had more complications than in-house ECLS patients, clinical outcomes were comparable in the matched population. Transporting ECLS patients to an experienced centre may be justified based on our experience.
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Affiliation(s)
- Heemoon Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keumhee Chough Carriere
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada.,Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Hyun Ahn
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Bertoldi LF, Pappalardo F, Lubos E, Grahn H, Rybczinski M, Barten MJ, Legros T, Bertoglio L, Schrage B, Westermann D, Lapenna E, Reichenspurner H, Bernhardt AM. Bridging INTERMACS 1 patients from VA-ECMO to LVAD via Impella 5.0: De-escalate and ambulate. J Crit Care 2020; 57:259-263. [DOI: 10.1016/j.jcrc.2019.12.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/25/2019] [Accepted: 12/31/2019] [Indexed: 10/25/2022]
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Pasrija C, Sawan MA, Sorensen E, Voorhees HJ, Shah A, Wang L, Ton VK, DiChiacchio L, Kaczorowski DJ, Griffith BP, Pham SM, Kon ZN. Less Invasive Approach to Left Ventricular Assist Device Implantation May Improve Survival in High-Risk Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:243-250. [PMID: 32379514 DOI: 10.1177/1556984520918959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Despite improvement in outcomes after left ventricular assist device (LVAD) implantation over the past 2 decades, high-risk recipients continue to have a prohibitive rate of morbidity and mortality. We hypothesized that a less invasive approach to LVAD implantation would be associated with improved survival compared to a conventional approach in this high-risk cohort. METHODS All consecutive LVAD recipients (2013 to 2017) that underwent centrifugal LVAD implantation were retrospectively reviewed. Patients were classified as high-risk if INTERMACS 1 or required temporary VAD/venoarterial extracorporeal membrane oxygenation prior to durable VAD implantation. Patients were stratified into 3 groups: left thoracotomy with hemi-sternotomy (LTHS) high-risk, conventional sternotomy (CS) high-risk, and non-high-risk. The primary outcome was 1-year survival. RESULTS A total of 57 patients (LTHS high-risk: 11, CS high-risk: 12, non-high-risk: 34) were identified. Preoperative right ventricular failure scores, HeartMate-II mortality scores, and end-organ dysfunction were similar between the 2 high-risk groups. While operative time was similar between the 3 groups, cardiopulmonary bypass time was significantly shorter in the LTHS high-risk group compared to other groups. There was a trend toward decreased intensive care unit length of stay and ventilator time in LTHS high-risk compared to CS high-risk patients. Moreover, between these 2 groups, there was a significant decrease in temporary right VAD support (50% vs 0%, P = 0.014), and 1-year survival was significantly higher in the LTHS group (42% vs 91%, P = 0.025). CONCLUSIONS Less invasive LVAD implantation appears to be associated with improved survival compared to conventional LVAD implantation in high-risk patients.
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Affiliation(s)
- Chetan Pasrija
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mariem A Sawan
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Erik Sorensen
- 21668 Division of Clinical Engineering, University of Maryland Medical Center, Baltimore, MD, USA
| | - Hannah Joy Voorhees
- 21668 Division of Clinical Engineering, University of Maryland Medical Center, Baltimore, MD, USA
| | - Aakash Shah
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Libin Wang
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Van-Khue Ton
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laura DiChiacchio
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David J Kaczorowski
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bartley P Griffith
- 12264 Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Si M Pham
- 23389 Department of Cardiothoracic Surgery, Mayo Medical Center, Jacksonville, FL, USA
| | - Zachary N Kon
- 12297 Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
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Eckman PM, Katz JN, El Banayosy A, Bohula EA, Sun B, van Diepen S. Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Circulation 2019; 140:2019-2037. [DOI: 10.1161/circulationaha.119.034512] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Extracorporeal membrane oxygenation has evolved, from a therapy that was selectively applied in the pediatric population in tertiary centers, to more widespread use in diverse forms of cardiopulmonary failure in all ages. We provide a practical review for cardiovascular clinicians on the application of veno-arterial extracorporeal membrane oxygenation in adult patients with cardiogenic shock, including epidemiology of cardiogenic shock, indications, contraindications, and the extracorporeal membrane oxygenation circuit. We also summarize cannulation techniques, practical management and troubleshooting, prognosis, and weaning and exit strategies, with attention to end of life and ethical considerations.
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Affiliation(s)
| | - Jason N. Katz
- Department of Medicine, Duke University Medical Center, Durham, NC (J.N.K.)
| | - Aly El Banayosy
- Department of Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, OK (A.E.B.)
| | - Erin A. Bohula
- Thrombosis in Myocardial Infarction Study Group, Department of Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (E.A.B.)
| | | | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (S.V.D.)
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Urban M, Siddique A, Moulton MM, Castleberry AW, Merritt-Genore H, Ryan T, Lowes B, Um JY. Can we expect improvements in outcomes with centrifugal vs axial flow left ventricular assist devices in patients transitioned from extracorporeal life support? J Card Surg 2019; 34:1228-1234. [PMID: 31478259 DOI: 10.1111/jocs.14232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several patient-related characteristics have been associated with inferior outcomes following durable left ventricular assist device (LVAD) implantation in patients transitioned from venoarterial extracorporeal membrane oxygenation (VA ECMO). The impact of LVAD pump type used is less well-known. METHODS We compared outcomes between patents who received axial and centrifugal flow LVADs following stabilization with VA ECMO. RESULTS From January 2011 to December 2018, we implanted 28 LVADs in patients transitioned from VA ECMO. This included 17 axial flow devices (HeartMate II LVAD, Abbott Laboratories, Chicago, IL) and 11 centrifugal flow pumps (eight HeartWare HVADs; Medtronic, Minneapolis, MN and three HeartMate 3 LVAS pumps; Abbott Laboratories, Chicago, IL). There was no difference in hospital mortality (23.5% vs 18.2%, P = .74) or 1-year survival (P = .31) between the devices. There were no differences in adverse event rates between the two pump types, apart from a higher rate of gastrointestinal bleeding in patients who received centrifugal flow pumps (1.44 events per 100 patient-months vs 14.67 events per 100 patient-months, P = .010). Preimplantation levels of alanine aminotransferase (hazard ratio [HR], 1.001; 95% confidence interval [CI], 1.000 to 1.002; P = .004) and elevated serum creatinine level (HR, 3.480; 95% CI, 1.121-10.807; P = .031) emerged as significant predictors of decreased 1-year survival. CONCLUSIONS Preimplantation optimization of end-organ function is the single most important determinant of successful post-LVAD survival in patients transitioned from extracorporeal life support. There is no association of pump type with LVAD outcomes up to 1-year post implantation.
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Affiliation(s)
- Marian Urban
- Division of Cardiothoracic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Aleem Siddique
- Division of Cardiothoracic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Michael M Moulton
- Division of Cardiothoracic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Anthony W Castleberry
- Division of Cardiothoracic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - HelenMari Merritt-Genore
- Division of Cardiothoracic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Timothy Ryan
- Division of Cardiothoracic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Brian Lowes
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - John Y Um
- Division of Cardiothoracic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE
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Ljajikj E, Zittermann A, Koster A, Börgermann J, Schönbrodt M, Hakim-Meibodi K, Gummert J, Morshuis M. Extracorporeal resuscitation as a further modifier of clinical outcome in patients with left ventricular assist device implantation and Interagency Registry for Mechanically Assisted Circulatory Support level 1. Interact Cardiovasc Thorac Surg 2019; 27:139-141. [PMID: 29444276 DOI: 10.1093/icvts/ivx433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/21/2017] [Indexed: 02/04/2023] Open
Abstract
In cardiogenic shock patients with Interagency Registry for Mechanical Circulatory Support (INTERMACS) level 1, the need for temporary circulatory support is a predictor and modifier of patient outcome. Because this group includes patients with and without cardiopulmonary resuscitation (CPR) and is thus very heterogeneous, we investigated whether a further subclassification is useful. We compared 30-day and 1-year mortality of patients who underwent left ventricular assist device implantation after extracorporeal CPR with the aid of an extracorporeal life support system (CPR+ group; n = 40) with cardiogenic shock patients in which the extracorporeal life support system was implanted under non-CPR conditions (CPR- group, n = 68). In the CPR+ and CPR- groups, 30-day mortality was 27.5% (n = 11) and 8.8% (n = 6), respectively (P = 0.014). The values for 1-year mortality were 57.5% (n = 23) and 36.8% (n = 25), respectively (P = 0.023). The age- and gender-adjusted hazard ratios of 30-day and 1-year mortality for the CPR+ group versus the CPR- group were 3.88 (95% confidence interval 1.29-11.7; P = 0.016) and 1.79 (95% confidence interval 1.01-3.17; P = 0.045), respectively. In conclusion, our data show that left ventricular assist device implantation with extracorporeal life support following CPR is associated with high 30-day and 1-year mortality. Further multicentre studies are needed to confirm these results and potentially add CPR as a new modifier to the INTERMACS profile.
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Affiliation(s)
- Edis Ljajikj
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Andreas Koster
- Institute of Anesthesiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michael Schönbrodt
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
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11
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Sawa Y, Matsumiya G, Matsuda K, Tatsumi E, Abe T, Fukunaga K, Ichiba S, Taguchi T, Kokubo K, Masuzawa T, Myoui A, Nishimura M, Nishimura T, Nishinaka T, Okamoto E, Tokunaga S, Tomo T, Tsukiya T, Yagi Y, Yamaoka T. Journal of Artificial Organs 2018: the year in review : Journal of Artificial Organs Editorial Committee. J Artif Organs 2019; 22:1-5. [PMID: 30796540 DOI: 10.1007/s10047-019-01094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Y Sawa
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - G Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - K Matsuda
- Emergency and Critical Care Medicine, University of Yamanashi Hospital, Yamanashi, Japan
| | - E Tatsumi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - T Abe
- Department of Urology, Iwate Medical University School of Medicine, Iwate, Japan
| | - K Fukunaga
- Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| | - S Ichiba
- Department of Surgical Intensive Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - T Taguchi
- Biomaterial Unit, National Institute of Material Science, Ibaraki, Japan
| | - K Kokubo
- Department of Medical Engineering and Technology, Kitasato University School of Allied Health Science, Kanagawa, Japan
| | - T Masuzawa
- Department of Mechanical Engineering, Ibaraki University, Ibaraki, Japan
| | - A Myoui
- Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan
| | - M Nishimura
- Division of Organ Regeneration Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - T Nishimura
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - T Nishinaka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - E Okamoto
- Department of Human Science and Informatics, School of Bioscience and Engineering, Tokai University, Sapporo, Japan
| | - S Tokunaga
- The Department of Cardiovascular Surgery, JCHO Kyushu Hospital, Fukuoka, Japan
| | - T Tomo
- Second Department of Internal Medicine, Faculty of Medicine, Oita University, Oita, Japan
| | - T Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Y Yagi
- Department of Clinical Engineering, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Yamaoka
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
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