Implanting Durable VAD Systems in Patients on VA-ECMO: Comparing Less Invasive to Sternotomy Approach. On Behalf of ECMO-VAD Study Group

D. Saeed, E. V. Potapov, A. Loforte, M. Morshuis, D. Schibilsky, D. Zimpfer, J. Riebandt, F. Pappalardo, M. Attisani, A. Haneya, F. Ramjankhan, D. Donker, D. Tsyganenko, U. Jorde, K. Jawad, R. Wieloch, R. Ayala, C. Aspern, J. Cremer, M. BorgerA. Lichtenberg, J. F. Gummert

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Abstract

PURPOSE: Patients on veno-arterial membrane oxygenation (VA-ECMO) are high-risk candidates for durable ventricular assist device (VAD) surgery. The aim of this study was to compare the outcome of patients who received durable VAD on VA-ECMO using less invasive (LIS) vs. sternotomy approach. METHODS: Data of eleven high volume VA-ECMO/VAD centers are collected and evaluated to identify patients who underwent VAD implantation after ECMO support between January 2010 and July 2018. Preoperative parameters and postoperative outcome are analyzed. RESULTS: A total of 531 patients met the inclusion criteria. Nineteen patients were supported with Cardiowest TAH and were excluded from this analysis. The remaining 512 patients were 1:3 propensity score matched and resulted in 99 patients remained in LIS group vs. 293 patients in sternotomy group. The total surgery time was significantly longer in the sternotomy group (270±80 vs. 203±61 min; p<0.001). The postoperative chest tube Output was comparable between the groups (p= 0.476). The number of postoperative PRBC, FFP and platelets given were comparable (p=0.296, 0.081 and 0.111 respectively). A temporary postoperative RVAD was necessary in 37% vs. 43% of the patients in LIS vs. sternotomy, respectively (p=0.353). Surgical re-exploration for bleeding was necessary in 39% vs. 34% of patients in LIS vs. sternotomy (p=0.345). Stroke rate was not statistically different in both groups (25% vs 17%, p = 0.097). Renal and liver failure rates were comparable with 31% vs. 30% and 28% vs 22% (LIS vs. sternotomy, p= 0.762 and 0.173). Comparison of the postoperative outcome between the two groups demonstrated superior short and long-term survival for LIS patients (p=0.015) (Figure 1) CONCLUSION: This study shows that LIS approach may be superior to sternotomy approach for patients on VA-ECMO. The postoperative morbidities were comparable. However, a superior short and long term outcome was observed in LIS Group.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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    Saeed, D., Potapov, E. V., Loforte, A., Morshuis, M., Schibilsky, D., Zimpfer, D., Riebandt, J., Pappalardo, F., Attisani, M., Haneya, A., Ramjankhan, F., Donker, D., Tsyganenko, D., Jorde, U., Jawad, K., Wieloch, R., Ayala, R., Aspern, C., Cremer, J., ... Gummert, J. F. (2020). Implanting Durable VAD Systems in Patients on VA-ECMO: Comparing Less Invasive to Sternotomy Approach. On Behalf of ECMO-VAD Study Group. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 39(4), S188. https://doi.org/10.1016/j.healun.2020.01.777