Diyar Saeed1, Evgenij Potapov2, Antonio Loforte3, Michiel Morshuis4, David Schibilsky5, Daniel Zimpfer6, Julia Riebandt6, Federico Pappalardo7, Matteo Attisani8, Mauro Rinaldi8, Assad Haneya9, Faiz Ramjankhan10, Dirk W Donker10, Ulrich P Jorde11, Julia Stein12, Dmytro Tsyganenko12, Khalil Jawad13, Radi Wieloch14, Rafael Ayala5, Jochen Cremer9, Michael A Borger13, Artur Lichtenberg14, Jan Gummert4. 1. Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Department for Cardiac Surgery, Duesseldorf University Hospital, Duesseldorf, Germany. Electronic address: diyar.saeed@helios-gesundheit.de. 2. Department of Cardiac Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany. 3. Department of Cardiac Surgery, Bologna University, Bologna, Italy. 4. Department of Cardiovascular and Thoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany. 5. Department of Cardiac and Vascular Surgery, Freiburg University, Freiburg, Germany. 6. Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria. 7. Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Hospital, Vita Salute University, Milan, Italy. 8. Department of Cardiac Surgery, University of Turin, Turin, Italy. 9. Department of Cardiac Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany. 10. Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands. 11. Department of Medicine, Montefiore Medical Center, Bronx, New York, USA. 12. Department of Cardiac Surgery, German Heart Center Berlin, Berlin, Germany. 13. Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany. 14. Department for Cardiac Surgery, Duesseldorf University Hospital, Duesseldorf, Germany.
Abstract
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.
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.
Authors: 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 Journal: Interact Cardiovasc Thorac Surg Date: 2022-03-31
Authors: Diyar Saeed; Evgenij Potapov; Antonio Loforte; Michiel Morshuis; David Schibilsky; Daniel Zimpfer; Julia Riebandt; Federico Pappalardo; Matteo Attisani; Mauro Rinaldi; Davide Pacini; Assad Haneya; Faiz Ramjankhan; Dirk W Donker; Ulrich P Jorde; Wolfgang Otto; Julia Stein; Dmytro Tsyganenko; Ameen Al-Naamani; Radi Wieloch; Rafael Ayala; Jochen Cremer; Michael Borger; Artur Lichtenberg; Jan Gummert Journal: Ann Cardiothorac Surg Date: 2021-05
Authors: Ioannis Mastoris; Joseph E Tonna; Jinxiang Hu; Andrew J Sauer; Nicholas A Haglund; Peter Rycus; Yu Wang; William J Wallisch; Travis O Abicht; Matthew R Danter; Ryan J Tedford; James C Fang; Zubair Shah Journal: Circ Heart Fail Date: 2021-12-09 Impact factor: 8.790