TY - JOUR
T1 - Unloading of the Left Ventricle During Venoarterial Extracorporeal Membrane Oxygenation Therapy in Cardiogenic Shock
AU - Schrage, Benedikt
AU - Burkhoff, Daniel
AU - Rübsamen, Nicole
AU - Becher, Peter Moritz
AU - Schwarzl, Michael
AU - Bernhardt, Alexander
AU - Grahn, Hanno
AU - Lubos, Edith
AU - Söffker, Gerold
AU - Clemmensen, Peter
AU - Reichenspurner, Hermann
AU - Blankenberg, Stefan
AU - Westermann, Dirk
PY - 2018/12
Y1 - 2018/12
N2 - Objectives: This report relates the authors’ ongoing experience with percutaneous left ventricular (LV) unloading by using a transaortic LV assist device in combination with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and provides an in-depth analysis of the hemodynamic benefit of this approach. Background: VA-ECMO is increasingly used in cases of severe cardiogenic shock. However, increase in afterload with subsequent LV overload is a major drawback of VA-ECMO. Methods: Consecutive patients were treated with a transaortic LV assist device in addition to VA-ECMO for cardiogenic shock. The primary endpoint was 30-day all-cause mortality. Additional endpoints included weaning from VA-ECMO and safety endpoints. Results: Between September 2013 and January 2018, 106 patients were treated with percutaneous LV unloading, using a transaortic LV assist device in combination with VA-ECMO. Successful weaning from VA-ECMO support was achieved in 51.9% of all patients. In the overall cohort, survival at day 30 was 35.8%, which was higher than predicted by the SAVE score (20%) or by the SAPS-II score (6.9%). Right heart catheterization indicated a marked decrease of PCWP after addition of the device to VA-ECMO. Conclusions: The strategy of percutaneous LV unloading using a transaortic LV assist device in combination with VA-ECMO improved outcome in an all-comers cohort compared to established risk scores. A prospective, randomized study is needed to further investigate this approach.
AB - Objectives: This report relates the authors’ ongoing experience with percutaneous left ventricular (LV) unloading by using a transaortic LV assist device in combination with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and provides an in-depth analysis of the hemodynamic benefit of this approach. Background: VA-ECMO is increasingly used in cases of severe cardiogenic shock. However, increase in afterload with subsequent LV overload is a major drawback of VA-ECMO. Methods: Consecutive patients were treated with a transaortic LV assist device in addition to VA-ECMO for cardiogenic shock. The primary endpoint was 30-day all-cause mortality. Additional endpoints included weaning from VA-ECMO and safety endpoints. Results: Between September 2013 and January 2018, 106 patients were treated with percutaneous LV unloading, using a transaortic LV assist device in combination with VA-ECMO. Successful weaning from VA-ECMO support was achieved in 51.9% of all patients. In the overall cohort, survival at day 30 was 35.8%, which was higher than predicted by the SAVE score (20%) or by the SAPS-II score (6.9%). Right heart catheterization indicated a marked decrease of PCWP after addition of the device to VA-ECMO. Conclusions: The strategy of percutaneous LV unloading using a transaortic LV assist device in combination with VA-ECMO improved outcome in an all-comers cohort compared to established risk scores. A prospective, randomized study is needed to further investigate this approach.
KW - cardiogenic shock
KW - left ventricular unloading
KW - VA-ECMO
UR - https://www.scopus.com/pages/publications/85056568787
U2 - 10.1016/j.jchf.2018.09.009
DO - 10.1016/j.jchf.2018.09.009
M3 - Article
C2 - 30497643
AN - SCOPUS:85056568787
SN - 2213-1779
VL - 6
SP - 1035
EP - 1043
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 12
ER -