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Iversen IJ, Gustafsson F, Rossing K, Møller-Sørensen PH, Olsen PS, Møller CH. Single center outcomes after temporary mechanical circulatory assist device prior to Heartmate 3 implantation - a retrospective cohort study. SCAND CARDIOVASC J 2024; 58:2353066. [PMID: 38962929 DOI: 10.1080/14017431.2024.2353066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/05/2024] [Indexed: 07/05/2024]
Abstract
Objectives. Temporary mechanical circulatory support (TMCS) has become a component in the therapeutic strategy for treatment of cardiogenic shock as a bridge-to-decision. TMCS can facilitate recovery of cardiopulmonary function, end-organ function, and potentially reduce the surgical risk of left ventricular assist device (LVAD) implantation. Despite the improvements of hemodynamics and end-organ function, post-LVAD operative morbidity might be increased in these high-risk patients. The aim of the study was to compare outcomes after Heartmate 3 (HM3) implantation in patients with and without TMCS prior to HM3 implant. Methods. In this retrospective cohort study of all HM3 patients in the period between November 2015 and October 2021, patients with and without prior TMCS were compared. Patients' demographics, baseline clinical characteristics, laboratory tests, intraoperative variables, postoperative outcomes, and adverse events were collected from patient records. Results. The TMCS group showed an improvement in hemodynamics prior to LVAD implantation. Median TMCS duration was 19.5 (14-26) days. However, the TMCS group were more coagulopathic, had more wound infections, neurological complications, and more patients were on dialysis compared with patient without TMCS prior to HM3 implantation. Survival four years after HM3 implantation was 80 and 82% in the TMCS (N = 22) and non-TMCS group (N = 41), respectively. Conclusion. Patients on TMCS had an acceptable short and long-term survival and comparable to patients receiving HM3 without prior TMCS. However, they had a more complicated postoperative course.
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Affiliation(s)
- Imran Jamal Iversen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Rossing
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Hasse Møller-Sørensen
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter Skov Olsen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Holdflod Møller
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Noly PE, Moriguchi J, Shah KB, Anyanwu AC, Mahr C, Skipper E, Cossette M, Lamarche Y, Carrier M. A bridge-to-bridge approach to heart transplantation using extracorporeal membrane oxygenation and total artificial heart. J Thorac Cardiovasc Surg 2023; 165:1138-1148.e1. [PMID: 34627602 DOI: 10.1016/j.jtcvs.2021.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/29/2021] [Accepted: 09/07/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study aims to describe the outcomes after heart transplantation using a bridge-to-bridge strategy with a sequence of extracorporeal membrane oxygenation (ECMO) support followed by temporary total artificial heart implantation (TAH-t). METHODS A retrospective, multicenter analysis of 54 patients who underwent TAH-t implantation following an ECMO for cardiogenic shock was performed (ECMO-TAH-t group). A control group of 163 patients who underwent TAH-t implantation as a direct bridge to transplantation (TAH-t group) was used to assess this strategy's impact on outcomes. RESULTS Fifty-four patients, averaging 47 ± 13 year old, underwent implantation of a TAH-t after 5.3 ± 3.4 days of ECMO perfusion for cardiogenic shock. In the ECMO-TAH-t group, 20 patients (20/54%; 37%) died after TAH-t implantation and 57 patients (57/163%; 35%) died in the TAH-t group (Gray test; P = .49). The top 3 causes of death of patients on TAH-t support were multisystem organ failure (40%), sepsis (20%), and neurologic events (20%). Overall, 32 patients (32/54%; 59%) underwent heart transplantation in the ECMO-TAH-t group compared with 106 patients (106/163%, 65%) in the TAH-t group (P = .44). No significant difference in survival was observed at 6 months, 1 year, and 3 years after heart transplant (ECMO-TAH-t group: 94%, 87%, and 80% vs 87%, 83%, and 76% in the TAH-t group, respectively). Deterioration of liver function (bilirubin, aspartate transaminase, and alanine aminotransferase levels on TAH-t) was associated with increased mortality before heart transplant in both groups. CONCLUSIONS Sequential bridging from ECMO to TAH-t followed by heart transplantation is a viable option for a group of highly selected patients.
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Affiliation(s)
- Pierre-Emmanuel Noly
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
| | - Jaime Moriguchi
- Department of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, Calif
| | - Keyur B Shah
- Division of Cardiology, The Pauley Heart Center, Virginia Commonwealth University, Richmond, Va
| | - Anelechi C Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Claudius Mahr
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Wash
| | - Eric Skipper
- Department of Thoracic and Cardiovascular Surgery, Carolinas Medical Center, Charlotte, NC
| | - Mariève Cossette
- Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | - Yoan Lamarche
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Michel Carrier
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
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Coeckelenbergh S, Valente F, Mortier J, Engelman E, Roussoulières A, El Oumeiri B, Antoine M, Van Obbergh L, Taccone FS, Vanden Eynden F, Stefanidis C. Long-Term Outcome After Venoarterial Extracorporeal Membrane Oxygenation as Bridge to Left Ventricular Assist Device Preceding Heart Transplantation. J Cardiothorac Vasc Anesth 2021; 36:1694-1702. [PMID: 34330577 DOI: 10.1053/j.jvca.2021.06.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To 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). DESIGN A 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. SETTING University Hospital Erasme. PARTICIPANTS HT candidates requiring LVAD. INTERVENTIONS VA ECMO bridging to LVAD (ECMO-LVAD group [n = 24]) versus LVAD (LVAD group [n = 64]). MEASUREMENTS AND MAIN RESULTS Eighty-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). CONCLUSIONS VA 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.
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Affiliation(s)
- Sean Coeckelenbergh
- Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - Federica Valente
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Julien Mortier
- Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Edgard Engelman
- Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium; EW Data Analysis, Brussels, Belgium
| | - Ana Roussoulières
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Bachar El Oumeiri
- Department of Cardiac Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Martine Antoine
- Department of Cardiac Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Luc Van Obbergh
- Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Frédéric Vanden Eynden
- Department of Cardiac Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Constantin Stefanidis
- Department of Cardiac Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Improving Outcomes in INTERMACS Category 1 Patients with Pre-LVAD, Awake Venous-Arterial Extracorporeal Membrane Oxygenation Support. ASAIO J 2019; 65:819-826. [DOI: 10.1097/mat.0000000000000908] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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5
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Predictors of mid-term outcomes in patients undergoing implantation of a ventricular assist device directly after extracorporeal life support. Eur J Cardiothorac Surg 2018; 55:773-779. [DOI: 10.1093/ejcts/ezy351] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/23/2018] [Accepted: 09/13/2018] [Indexed: 01/07/2023] Open
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Quality of Life and Mid-Term Survival of Patients Bridged with Extracorporeal Membrane Oxygenation to Left Ventricular Assist Device. ASAIO J 2017; 63:273-278. [DOI: 10.1097/mat.0000000000000471] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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7
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Beyersdorf F. New dimensions for extracorporeal circulation. Interact Cardiovasc Thorac Surg 2017; 24:479-481. [DOI: 10.1093/icvts/ivx086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Hennig F, Potapov EV, Falk V, Krabatsch T. Rapid Application Is Crucial. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:39-40. [PMID: 26857514 DOI: 10.3238/arztebl.2016.0039c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Aubin H, Petrov G, Dalyanoglu H, Saeed D, Akhyari P, Paprotny G, Richter M, Westenfeld R, Schelzig H, Kelm M, Kindgen-Milles D, Lichtenberg A, Albert A. A Suprainstitutional Network for Remote Extracorporeal Life Support. JACC-HEART FAILURE 2016; 4:698-708. [DOI: 10.1016/j.jchf.2016.03.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/18/2016] [Accepted: 03/26/2016] [Indexed: 10/21/2022]
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Banfi C, Pozzi M, Brunner ME, Rigamonti F, Murith N, Mugnai D, Obadia JF, Bendjelid K, Giraud R. Veno-arterial extracorporeal membrane oxygenation: an overview of different cannulation techniques. J Thorac Dis 2016; 8:E875-E885. [PMID: 27747024 DOI: 10.21037/jtd.2016.09.25] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has known a widespread application over the last decade and is now an effective and valuable therapeutic option in refractory cardiogenic shock of various etiologies. In this subgroup of critically ill and unstable patients in cardiogenic shock, VA-ECMO allows, on the one hand, temporary hemodynamic stabilization with improvement of end-organ function and, on the other hand, gives the time to perform complementary diagnostic exams and to decide the therapeutic strategy in these high-risk candidates for immediate long-term mechanical circulatory support (MCS) implantation. VA-ECMO could also be suggested as a rescue therapeutic option for refractory cardiac arrest. It showed promising results in the specific setting of in-hospital cardiac arrest and survival rates with good neurological outcome are reported between 20% and 40%. Conversely, there are contrasting data in the literature about survival after VA-ECMO for out-of-hospital cardiac arrest, as results are highly dependent on low-flow time. The aim of the present report is to offer an overview of different cannulation techniques of VA-ECMO.
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Affiliation(s)
- Carlo Banfi
- Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland;; Faculty of Medicine, University of Geneva, Geneva, Switzerland;; Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France
| | - Marie-Eve Brunner
- Intensive Care Service, Department of Anesthesiology, Intensive Care and Pharmacology
| | - Fabio Rigamonti
- Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Murith
- Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland;; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Damiano Mugnai
- Division of Cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland;; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Francois Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France
| | - Karim Bendjelid
- Faculty of Medicine, University of Geneva, Geneva, Switzerland;; Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland ;; Intensive Care Service, Department of Anesthesiology, Intensive Care and Pharmacology
| | - Raphaël Giraud
- Faculty of Medicine, University of Geneva, Geneva, Switzerland;; Geneva Hemodynamic Research Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland ;; Intensive Care Service, Department of Anesthesiology, Intensive Care and Pharmacology
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11
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Pozzi M, Banfi C, Grinberg D, Koffel C, Bendjelid K, Robin J, Giraud R, Obadia JF. Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock due to myocarditis in adult patients. J Thorac Dis 2016; 8:E495-502. [PMID: 27499982 DOI: 10.21037/jtd.2016.06.26] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Myocarditis is an inflammatory disease of the heart muscle with established histological, immunological and immunohistochemical diagnostic criteria. Different triggers could be advocated as possible etiologies of myocarditis such as viral and non-viral infections, medications, systemic autoimmune diseases and toxic reactions. The spectrum of clinical presentations of myocarditis is broad and varies from subclinical asymptomatic courses to refractory cardiogenic shock. The prognosis of patients with myocarditis depends mainly on the severity of clinical presentation. In particular, myocarditis patients developing cardiogenic shock refractory to optimal maximal medical treatment may benefit from the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a temporary mechanical circulatory support (MCS). The aim of the present report is to offer a review of the most important articles of the literature showing the results of VA-ECMO in the specific setting of cardiogenic shock due to myocarditis in adult patients.
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Affiliation(s)
- Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Claude Bernard University, Lyon, France
| | - Carlo Banfi
- Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Daniel Grinberg
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Claude Bernard University, Lyon, France
| | - Catherine Koffel
- Department of Anesthesia and ICU, "Louis Pradel" Cardiologic Hospital, Claude Bernard University, Lyon, France
| | - Karim Bendjelid
- Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Jacques Robin
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Claude Bernard University, Lyon, France
| | - Raphaël Giraud
- Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Jean François Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Claude Bernard University, Lyon, France
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12
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Burke CR, McMullan DM. Extracorporeal Life Support for Pediatric Heart Failure. Front Pediatr 2016; 4:115. [PMID: 27812522 PMCID: PMC5071357 DOI: 10.3389/fped.2016.00115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/05/2016] [Indexed: 11/15/2022] Open
Abstract
Extracorporeal life support (ECLS) represents an essential component in the treatment of the pediatric patient with refractory heart failure. Defined as the use of an extracorporeal system to provide cardiopulmonary support, ECLS provides hemodynamic support to facilitate end-organ recovery and can be used as a salvage therapy during acute cardiorespiratory failure. Support strategies employed in pediatric cardiac patients include bridge to recovery, bridge to therapy, and bridge to transplant. Advances in extracorporeal technology and refinements in patient selection have allowed wider application of this therapy in pediatric heart failure patients.
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Affiliation(s)
- Christopher R Burke
- Division of Cardiac Surgery, Seattle Children's Hospital , Seattle, WA , USA
| | - D Michael McMullan
- Division of Cardiac Surgery, Seattle Children's Hospital , Seattle, WA , USA
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