Abstract 15786: Role of Percutaneous Veno-Arterial Extracorporeal Membrane Oxygenation as a Bridge to Long-term Left Ventricular Assist Device
OBJECTIVE: Percutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides emergency circulatory support for cardiogenic shock and can be used as a bridge to left ventricular assist device (LVAD) support. The purpose of this study was to determine risk factors for LVAD implantation in patients who required preoperative VA-ECMO support for cardiogenic shock.
METHODS: Between 1999 and 2010, 112 patients underwent LVAD implantation, of whom 31 required VA-ECMO as a bridge to long-term LVAD. VA-ECMO support was provided for 5.7±7.4 days and blood creatinine and total bilirubin levels before LVAD implantation were 1.9±1.8 and 3.7 ± 3.7 mg/dl, respectively.
RESULTS: Patients were assisted by LVAD for 573±390 days. Compared to patients without preoperative VA-ECMO, overall survival was significantly worse in those with preoperative VA-ECMO ( 81% vs 98% at 90 days, 74% vs 89% at 1 year after LVAD implantation, p=0.0319). However, VA-ECMO patients who survived more than 90 days after LVAD implantation had long-term survival comparable to those without VA-ECMO (92% at 1 year and 81% at 2 year after LVAD implantation). Logistic regression analysis revealed that preoperative hyperbilirubinemia (> 4.9 mg/dl) with prolonged mechanical ventilation (> 6 days) was a significant risk factor for 90-day mortality (OR, 24; 95% CI, 1.9-311; p=0.015) and those patients had significantly worse postoperative right ventricular stroke work index.
CONCLUSIONS: We found that VA-ECMO patients without the preoperative risk factor can maintain adequate right ventricular function after LVAD implantation and achieve long-term survival comparable to those without preoperative VA-ECMO. Our results suggest that percutaneous VA-ECMO can be used as a bridge to long-term LVAD in selected patients.
- © 2011 by American Heart Association, Inc.