TY - JOUR
T1 - Transition From Temporary to Durable Circulatory Support Systems
AU - on behalf of Durable MCS after ECLS Study Group
AU - Saeed, Diyar
AU - Potapov, Evgenij
AU - Loforte, Antonio
AU - Morshuis, Michiel
AU - Schibilsky, David
AU - Zimpfer, Daniel
AU - Riebandt, Julia
AU - Pappalardo, Federico
AU - Attisani, Matteo
AU - Rinaldi, Mauro
AU - Haneya, Assad
AU - Ramjankhan, Faiz
AU - Donker, Dirk W.
AU - Jorde, Ulrich P.
AU - Stein, Julia
AU - Tsyganenko, Dmytro
AU - Jawad, Khalil
AU - Wieloch, Radi
AU - Ayala, Rafael
AU - Cremer, Jochen
AU - Borger, Michael A.
AU - Lichtenberg, Artur
AU - Gummert, Jan
N1 - Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/12/22
Y1 - 2020/12/22
N2 - Background: The decision to implant durable mechanical circulatory systems (MCSs) in patients on extracorporeal life support (ECLS) is challenging due to expected poor outcomes in these patients. Objectives: The aim of this study was to identify outcome predictors that may facilitate future patient selection and decision making. Methods: The Durable MCS after ECLS registry is a multicenter retrospective study that gathered data on consecutive patients who underwent MCS implantation after ECLS between January 2010 and August 2018 in 11 high-volume European centers. Several perioperative parameters were collected. The primary endpoint was survival at 1 year after durable MCS implantation. Results: A total of 531 durable MCSs after ECLS were implanted during this period. The average patient age was 53 ± 12 years old. ECLS cannulation was peripheral in 87% of patients and 33% of the patients had history of cardiopulmonary resuscitation before ECLS implantation. The 30-day, 1-year, and 3-year actuarial survival rates were 77%, 53%, and 43%, respectively. The following predictors for 1-year outcome have been observed: age, female sex, lactate value, Model of End-Stage Liver Disease XI score, history of atrial fibrillation, redo surgery, and body mass index >30 kg/m2. On the basis of this data, a risk score and an app to estimate 1-year mortality was created. Conclusions: The outcome in patients receiving durable MCS after ECLS remains limited, yet preoperative factors may allow differentiating futile patients from those with significant survival benefit.
AB - Background: The decision to implant durable mechanical circulatory systems (MCSs) in patients on extracorporeal life support (ECLS) is challenging due to expected poor outcomes in these patients. Objectives: The aim of this study was to identify outcome predictors that may facilitate future patient selection and decision making. Methods: The Durable MCS after ECLS registry is a multicenter retrospective study that gathered data on consecutive patients who underwent MCS implantation after ECLS between January 2010 and August 2018 in 11 high-volume European centers. Several perioperative parameters were collected. The primary endpoint was survival at 1 year after durable MCS implantation. Results: A total of 531 durable MCSs after ECLS were implanted during this period. The average patient age was 53 ± 12 years old. ECLS cannulation was peripheral in 87% of patients and 33% of the patients had history of cardiopulmonary resuscitation before ECLS implantation. The 30-day, 1-year, and 3-year actuarial survival rates were 77%, 53%, and 43%, respectively. The following predictors for 1-year outcome have been observed: age, female sex, lactate value, Model of End-Stage Liver Disease XI score, history of atrial fibrillation, redo surgery, and body mass index >30 kg/m2. On the basis of this data, a risk score and an app to estimate 1-year mortality was created. Conclusions: The outcome in patients receiving durable MCS after ECLS remains limited, yet preoperative factors may allow differentiating futile patients from those with significant survival benefit.
KW - extracorporeal life support
KW - extracorporeal membrane oxygenation
KW - mechanical circulatory support
KW - outcome
KW - predictors
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U2 - 10.1016/j.jacc.2020.10.036
DO - 10.1016/j.jacc.2020.10.036
M3 - Article
C2 - 33334424
AN - SCOPUS:85097466324
SN - 0735-1097
VL - 76
SP - 2956
EP - 2964
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 25
ER -