Left ventricular assist device implants in patients on extracorporeal membrane oxygenation: Do we need cardiopulmonary bypass?

Federico Pappalardo, Evgenij Potapov, Antonio Loforte, Michiel Morshuis, David Schibilsky, Daniel Zimpfer, Julia Riebandt, Christian Etz, Matteo Attisani, Mauro Rinaldi, Assad Haneya, Faiz Ramjankhan, Dirk Donker, Ulrich P. Jorde, Daniel Lewin, Radi Wieloch, Rafael Ayala, Jochen Cremer, Letizia Bertoldi, Michael BorgerArtur Lichtenberg, Jan Gummert, Diyar Saeed

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: Implanting a durable left ventricular assist device (LVAD) in a patient on extracorporeal life support (ECLS) is challenging. The goal of this study was to compare the results of patients from a European registry who had a durable LVAD implanted with or without transition from ECLS to cardiopulmonary bypass (CPB). METHODS: A total of 531 patients on ECLS support who had an LVAD implant between January 2010 and August 2018 were analysed; after 1:1 propensity score matching, we identified and compared 175 patients in each group. RESULTS: The duration of preoperative ECLS was 7 [standard deviation (SD) 6] vs 7 (SD 6) days in patients with or without CPB (P = 0.984). The surgical time was longer in the CPB group [285 (SD 72) vs 209 [SD 75] min; P ≤ 0.001). The postoperative chest tube output was comparable [1513 (SD 1311) vs 1390 (SD 1121) ml; P = 0.3]. However, re-exploration for bleeding was necessary in 41% vs 29% of patients with or without CPB (P = 0.01) and a significantly higher number of packed red blood cells and fresh frozen plasma [8 (SD 8) vs 6 (SD 4) units; P = 0.001 and 6 (SD 7) vs 5 (SD 5) units; P = 0.03] were administered to patients operated on with CPB. A postoperative mechanical right ventricular support device was necessary in 50% vs 41% of patients (P = 0.08). The stroke rate was not significantly different (P 0.99). No difference in survival was observed. CONCLUSIONS: Omitting CPB for an LVAD implant in patients on ECLS is safe and results in shorter operating time, less re-exploration for bleeding and fewer blood products. However, no survival benefit is observed.

Original languageEnglish (US)
Pages (from-to)676-682
Number of pages7
JournalInteractive Cardiovascular and Thoracic Surgery
Volume34
Issue number4
DOIs
StatePublished - Apr 1 2022

Keywords

  • CPB
  • ECLS
  • assist device
  • mechanical circulatory support
  • outcome

ASJC Scopus subject areas

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

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