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 Borger; Artur Lichtenberg; Jan Gummert; Diyar Saeed

doi:10.1093/icvts/ivab311

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

Medicine

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

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 language	English (US)
Pages (from-to)	676-682
Number of pages	7
Journal	Interactive Cardiovascular and Thoracic Surgery
Volume	34
Issue number	4
DOIs	https://doi.org/10.1093/icvts/ivab311
State	Published - 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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10.1093/icvts/ivab311

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Pappalardo, F., Potapov, E., Loforte, A., Morshuis, M., Schibilsky, D., Zimpfer, D., Riebandt, J., Etz, C., Attisani, M., Rinaldi, M., Haneya, A., Ramjankhan, F., Donker, D., Jorde, U. P., Lewin, D., Wieloch, R., Ayala, R., Cremer, J., Bertoldi, L., ... Saeed, D. (2022). Left ventricular assist device implants in patients on extracorporeal membrane oxygenation: Do we need cardiopulmonary bypass? Interactive Cardiovascular and Thoracic Surgery, 34(4), 676-682. https://doi.org/10.1093/icvts/ivab311

Pappalardo, F, Potapov, E, Loforte, A, Morshuis, M, Schibilsky, D, Zimpfer, D, Riebandt, J, Etz, C, Attisani, M, Rinaldi, M, Haneya, A, Ramjankhan, F, Donker, D, Jorde, UP, Lewin, D, Wieloch, R, Ayala, R, Cremer, J, Bertoldi, L, Borger, M, Lichtenberg, A, Gummert, J & Saeed, D 2022, 'Left ventricular assist device implants in patients on extracorporeal membrane oxygenation: Do we need cardiopulmonary bypass?', Interactive Cardiovascular and Thoracic Surgery, vol. 34, no. 4, pp. 676-682. https://doi.org/10.1093/icvts/ivab311

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

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.",

keywords = "CPB, ECLS, assist device, mechanical circulatory support, outcome",

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

note = "Publisher Copyright: {\textcopyright} 2021 The Author(s). Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.",

year = "2022",

month = apr,

day = "1",

doi = "10.1093/icvts/ivab311",

language = "English (US)",

volume = "34",

pages = "676--682",

journal = "Interactive Cardiovascular and Thoracic Surgery",

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publisher = "European Association for Cardio-Thoracic Surgery",

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TY - JOUR

T1 - Left ventricular assist device implants in patients on extracorporeal membrane oxygenation

T2 - Do we need cardiopulmonary bypass?

AU - Pappalardo, Federico

AU - Potapov, Evgenij

AU - Loforte, Antonio

AU - Morshuis, Michiel

AU - Schibilsky, David

AU - Zimpfer, Daniel

AU - Riebandt, Julia

AU - Etz, Christian

AU - Attisani, Matteo

AU - Rinaldi, Mauro

AU - Haneya, Assad

AU - Ramjankhan, Faiz

AU - Donker, Dirk

AU - Jorde, Ulrich P.

AU - Lewin, Daniel

AU - Wieloch, Radi

AU - Ayala, Rafael

AU - Cremer, Jochen

AU - Bertoldi, Letizia

AU - Borger, Michael

AU - Lichtenberg, Artur

AU - Gummert, Jan

AU - Saeed, Diyar

PY - 2022/4/1

Y1 - 2022/4/1

N2 - 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.

AB - 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.

KW - CPB

KW - ECLS

KW - assist device

KW - mechanical circulatory support

KW - outcome

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

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