Thorac Cardiovasc Surg 2020; 68(S 01): S1-S72
DOI: 10.1055/s-0040-1705396
Oral Presentations
Monday, March 2nd, 2020
Mechanical Circulatory Support
Georg Thieme Verlag KG Stuttgart · New York

Implanting Durable VAD Systems in Patients on VA-ECMO: Comparing Less Invasive to Sternotomy Approach—On Behalf of ECMO-VAD Study Group

D. Saeed
1   Leipzig, France
,
E. Potapov
2   Berlin, Germany
,
D. Schibilsky
3   Freiburg im Breisgau, Germany
,
D. Zimpfer
4   Wien, Austria
,
A. Haneya
5   Kiel, Germany
,
A. Loforte
6   Bologna, Italy
,
A. Lichtenberg
7   Düsseldorf, Germany
,
F. Ramjankhan
8   Utrecht, Netherlands
,
M. Borger
9   Leipzig, Germany
,
J. Gummert
10   Bad Oeynhausen, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
13 February 2020 (online)

Objectives: Patients on venoarterial membrane oxygenation (VA-ECMO) are high-risk candidates for durable ventricular assist device (VAD) surgery. It is unknown if less invasive VAD implantation (LIS) offers any advantage in this high-risk patient population. The aim of this study was to compare the outcome of patients who received durable VAD on VA-ECMO using LIS versus sternotomy approach.

Methods: Data of 11 high-volume VA-ECMO/VAD centers are collected and evaluated to identify patients who underwent VAD implantation after ECMO support between January 2010 and July 2018. Preoperative parameters and postoperative outcome are analyzed. Propensity score analysis was performed to identify two identical groups: LIS group versus sternotomy group. These two groups were then compared for outcome after VAD surgery.

Results: A total of 531 patients met the inclusion criteria. Nineteen patients were supported with CardioWest TAH and were excluded from this analysis. The remaining 512 patients were 1:3 propensity score matched and resulted in 99 patients remained in LIS group versus 293 patients in sternotomy group. The average age of the patients in LIS versus sternotomy group was 52 ± 10 and 53 ± 11 years old (p = 0.273). The total surgery time was significantly longer in the sternotomy group (270 ± 80 vs. 203 ± 61 min; < p < 0.001). The postoperative chest tube output on the day of surgery was comparable between the groups (1,337 ± 922 vs. 1,460 ± 1,012 mL, p = 0.476). The numbers of postoperative PRBC, FFP, and platelets given were comparable (p = 0.296, 0.081 and 0.111, respectively). A temporary postoperative right ventricular assist device implantation was necessary in 37 versus 43% of the patients in LIS versus sternotomy, respectively (p = 0.353). Surgical reexploration for bleeding was necessary in 39 versus 34% of patients in LIS versus sternotomy (p = 0.345). Stroke rate was not statistically different in both groups (25 vs. 17%, p = 0.097). Renal and liver failure rates were comparable with 31 versus 30% and 28 versus 22% (LIS vs. sternotomy, p = 0.762 and 0.173). The 30-day mortality was 10 versus 27% (LIS vs. sternotomy; < p < 0.001). Comparison of the postoperative outcome between the two groups demonstrated superior long-term survival for LIS patients (p = 0.015).

Conclusion: This study shows that LIS approach may be superior to sternotomy approach for patients on VA-ECMO. Shorter duration of surgery was observed. The postoperative morbidities were comparable. However, a superior short- and long-term outcome was observed in LIS group.