Abstract 337: Extracorporeal Life Support with Selective Left Ventricular Decompression Improves Outcome After Cardiogenic Shock with Concomitant Lung Failure
Introduction: Extracorporeal life support (ECLS) is a routine procedure for the treatment of cardiogenic shock or lung failure. Within this retrospective single center study we examined differences in outcome and clinical parameters of peripheral veno-arterial and central veno-arterial ECLS with or without left ventricular decompression.
Methods: Between April 2004 and February 2014, collectively 70 patients with INTERMACS 1 heart failure and a mean age of 34,9 ± 27.3 obtained ECLS (peripheral ECLS 14.3%, central ECLS + vent 47,1% and central ECLS w/o vent 38.0%). Most common cause for cardiopulmonal decompesation was dilatative cardiomyopathy (15.7%), myocarditis (15.7%) and acute myocardial infarction (8.6%). Children younger than 10 years were examined separately (n=22).
Results: Patient follow up was 100% with a mean survival of 1.70 years (±0.47) for adults and 2.41 years (±0.51) for infants. Bridge to recovery was feasible in 21.4%, bridge to transplant in 8.8% and 20% were bridged successfully to ventricular assist device. One-year survival of adults after central ECLS is superior to peripheral ECLS (log rank test, p=0.014) and late postoperative serum lactate level was notably lower (12.52 vs. 46.14mg/dl, p=0.00). If a left ventricular vent was implanted, 1-year survival was better (log rank test p=0.004) and horovitz index significantly greater (214.21 vs. 109.38, p=0.015) for patients with central ECLS. Although we could not see any statistical difference in cumulative survival in the pediatric cases, infants without left heart decompression presented late postoperative significantly more often a reduced ejection fraction (p=0.013).
Conclusion: Independent of the underlying disease ECLS has an acceptable overall outcome in adults. Patients who underwent central ECLS with left ventricular decompression present superior survival after one year and better postoperative oxygenation.
Author Disclosures: C. Alt: None. P.C. Seppelt: None. B. Schmack: None. A. Weymann: None. M. Farag: None. R. Arif: None. K. Kallenbach: None. A.O. Doesch: None. P. Raake: None. T. Loukanov: None. M. Karck: None. A. Ruhparwar: None.
- © 2014 by American Heart Association, Inc.