Author + information
- Received June 27, 2018
- Revision received September 10, 2018
- Accepted September 19, 2018
- Published online November 26, 2018.
- Benedikt Schrage, MDa,b,
- Daniel Burkhoff, MD, PhDc,
- Nicole Rübsamen, PhDa,
- Peter Moritz Becher, MDa,
- Michael Schwarzl, MD, PhDa,b,
- Alexander Bernhardt, MDd,
- Hanno Grahn, MDa,
- Edith Lubos, MDa,
- Gerold Söffker, MDe,
- Peter Clemmensen, MDa,
- Hermann Reichenspurner, MD, PhDd,
- Stefan Blankenberg, MD, PhDa,b and
- Dirk Westermann, MD, PhDa,b,∗ ()
- aDepartment of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany
- bGerman Centre for Cardiovascular Research, Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- cCardiovascular Research Foundation, New York, New York
- dDepartment of Cardiovascular Surgery, University Heart Center Hamburg Eppendorf, Hamburg, Germany
- eDepartment of Intensive Care Medicine, University Clinic Hamburg Eppendorf, Hamburg, Germany
- ↵∗Address for correspondence:
Prof. Dr. Dirk Westermann, University Heart Centre Hamburg, Department of General and Interventional Cardiology, Martinistrasse 52, 20246 Hamburg, Germany.
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.
Supported by the University Heart Centre Hamburg Eppendorf. Dr. Schrage has received travel compensation from Abiomed. Dr. Burkhoff has received an educational grant from Abiomed. Dr. Reichenspurner has received travel compensation from, and is a consultant to Abiomed. Dr. Westermann has received travel compensation and speaker fees from Abiomed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 27, 2018.
- Revision received September 10, 2018.
- Accepted September 19, 2018.
- 2018 American College of Cardiology Foundation