Multicenter evaluation of left ventricular assist device implantation with or without ECMO bridge in cardiogenic shock

Abstract

AbstractBackgroundThe efficacy of extracorporeal membrane oxygenation (ECMO) as a bridge to left ventricular assist device (LVAD) remains unclear, and recipients of the more contemporary HeartMate 3 (HM3) LVAD are not well represented in previous studies. We therefore undertook a multicenter, retrospective study of this population.Methods and ResultsINTERMACS 1 LVAD recipients from five U.S. centers were included. In‐hospital and one‐year outcomes were recorded. The primary outcome was the overall mortality hazard comparing ECMO versus non‐ECMO patients by propensity‐weighted survival analysis. Secondary outcomes included survival by LVAD type, as well as postoperative and one‐year outcomes. One hundred and twenty‐seven patients were included; 24 received ECMO as a bridge to LVAD. Mortality was higher in patients bridged with ECMO in the primary analysis (HR 3.22 [95%CI 1.06–9.77], p = 0.039). Right ventricular assist device was more common in the ECMO group (ECMO: 54.2% vs non‐ECMO: 11.7%, p < 0.001). Ischemic stroke was higher at one year in the ECMO group (ECMO: 25.0% vs non‐ECMO: 4.9%, p = 0.006). Among the study cohort, one‐year mortality was lower in HM3 than in HeartMate II (HMII) or HeartWare HVAD (10.5% vs 46.9% vs 31.6%, respectively; p < 0.001) recipients. Pump thrombosis at one year was lower in HM3 than in HMII or HVAD (1.8% vs 16.1% vs 16.2%, respectively; p = 0.026) recipients.ConclusionsHigher mortality was observed with ECMO as a bridge to LVAD, likely due to higher acuity illness, yet acceptable one‐year survival was seen compared with historical rates. The receipt of the HM3 was associated with improved survival compared with older generation devices.