Evgenij Potapov1,2, Antonio Loforte3, Federico Pappalardo4, Michiel Morshuis5, David Schibilsky6, Daniel Zimpfer7, Daniel Lewin1, Julia Riebandt7, Konstantin Von Aspern8, Julia Stein1, Matteo Attisani9, Assad Haneya10, Faiz Ramjankhan11, Dirk W Donker11, Ulrich P Jorde12, Radi Wieloch13, Rafael Ayala6, Jochen Cremer10, Mauro Rinaldi9, Andrea Montisci14, Michael Borger8, Artur Lichtenberg13, Jan Gummert5, Diyar Saeed8,13. 1. Department of Cardiac Surgery, German Heart Center Berlin, Berlin, Germany. 2. DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany. 3. Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. 4. Advanced Heart Failure and Mechanical Circulatory Support Program, Vita-Salute San Raffaele University, Milan, Italy. 5. Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany. 6. Department of Cardiovascular Surgery, Freiburg University, Freiburg, Germany. 7. Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria. 8. Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany. 9. Department of Cardiac Surgery, University of Turin, Turin, Italy. 10. Department of Cardiac Surgery, University Hospital Schleswig Holstein, Kiel, Germany. 11. Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, Netherlands. 12. Department of Medicine, Montefiore Medical Center, Bronx, New York, USA. 13. Department of Cardiac Surgery, University Hospital Dusseldorf, Dusseldorf, Germany. 14. Department of Anesthesia and Intensive Care, Sant'Ambrogio Cardiothoracic Center, University of Milan, Milan, Italy.
Abstract
BACKGROUND: The aim of this study was to evaluate the impact of the surgical approach on the postoperative outcome in patients who underwent left ventricular assist device (LVAD) implantation after having received veno-arterial extracorporeal life support (va-ECLS) using data from a European registry (ECLS-VAD). Five hundred and thirty-one patients were included. METHODS: A propensity score-adjusted outcome analysis was performed, resulting in 324 patients in the full sternotomy (FS) group and 39 in the less invasive surgery (LIS) group. RESULTS: The surgery lasted in median 236 min in the FS group versus 263 min in the LIS group (p = 0.289). The median chest tube output during the first 24 h was similar in both groups. Patients who underwent implantation with an FS required more blood products during the first 24 postoperative hours (median 16 vs. 12, p = 0.033). The incidence of revision due to bleeding was also higher (35.5 vs. 15.4%, p = 0.016). A temporary postoperative right ventricular assist device was necessary in 45.1 (FS) versus 23.1% (LIS) of patients, respectively (p = 0.067). No stroke occurred in the LIS group during the first 30 days after surgery (7.4% in the FS group). The incidence of stroke and of renal, hepatic, and respiratory failure during the follow-up was similar in both groups. The 30-day and one-year survival were similar in both groups. CONCLUSION: LIS for implantation of a durable LVAD in patients on va-ECLS implanted for cardiogenic shock is associated with less revision due to bleeding, less administration of blood products and absence of perioperative stroke, with no impact on survival.
BACKGROUND: The aim of this study was to evaluate the impact of the surgical approach on the postoperative outcome in patients who underwent left ventricular assist device (LVAD) implantation after having received veno-arterial extracorporeal life support (va-ECLS) using data from a European registry (ECLS-VAD). Five hundred and thirty-one patients were included. METHODS: A propensity score-adjusted outcome analysis was performed, resulting in 324 patients in the full sternotomy (FS) group and 39 in the less invasive surgery (LIS) group. RESULTS: The surgery lasted in median 236 min in the FS group versus 263 min in the LIS group (p = 0.289). The median chest tube output during the first 24 h was similar in both groups. Patients who underwent implantation with an FS required more blood products during the first 24 postoperative hours (median 16 vs. 12, p = 0.033). The incidence of revision due to bleeding was also higher (35.5 vs. 15.4%, p = 0.016). A temporary postoperative right ventricular assist device was necessary in 45.1 (FS) versus 23.1% (LIS) of patients, respectively (p = 0.067). No stroke occurred in the LIS group during the first 30 days after surgery (7.4% in the FS group). The incidence of stroke and of renal, hepatic, and respiratory failure during the follow-up was similar in both groups. The 30-day and one-year survival were similar in both groups. CONCLUSION:LIS for implantation of a durable LVAD in patients on va-ECLS implanted for cardiogenic shock is associated with less revision due to bleeding, less administration of blood products and absence of perioperative stroke, with no impact on survival.
Authors: Alexander M Bernhardt; Benedikt Schrage; Ines Schroeder; Georg Trummer; Dirk Westermann; Hermann Reichenspurner Journal: Dtsch Arztebl Int Date: 2022-04-01 Impact factor: 8.251