Extracorporeal Life Support after Right Heart Failure in Patients Undergoing Left Ventricular Assist Device Implantation: Comparison of ra-pa-ECLS vs. va-ECLS

Objectives: Right heart failure in patients undergoing left ventricular assist device implantation is one major risk factor in patients with biventricular restriction. The implantation of a venoarterial extracorporeal life support (va-ECLS) has become a promising therapeutic option due to technologic innovations and fast application. We present our first results of different application techniques of extracorporeal life support: standard va-ECLS vs. ECLS with transvenous cannulation of the pulmonary artery (ra-pa-ECLS).

Methods: Data of patients with severe right heart failure after LVAD implantation who received either va-ECLS via standard technique (cannulation of femoral vein and artery, 77 patients) or a transjugular right heart bypass (ra-pa-ECLS, 14 patients) with cannulation of the pulmonary artery and the femoral vein between January 2011 and December 2017 in our institution was retrospectively analyzed.

Results: In the ra-pa-ECLS group, right ventricular function recovered in six patients and the RHB was successfully weaned (42.9%). Three patients were not weanable from RHB due to persisting right ventricular dysfunction. As no recovery of the right ventricular function was expected in these patients, they were successfully bridged to RVAD implantation (HVAD) (21.4%). One patient was successfully bridged to cardiac transplantation after 29 days of right heart assist (7.1%). 4 patients with RHB after LVAD implantation died, 2 of them receiving RHB after one day, one patient after 2 days and one patient after 38 days (28.6%). In the va-ECLS group, right ventricular function recovered in 26 patients and the ECLS was successfully weaned (33.8%) 3 patients were not weanable from va-ECLS due to persisting right ventricular dysfunction. As no recovery of right ventricular function was expected, they were also bridged to RVAD implantation (3.9%). 48 patients with standard va-ECLS died (62.3%). The overall survival in the ra-pa-ECLS-group was 71.4%, whereas the overall survival in the va-ECLS-group was 37.7%.

Conclusions: In conclusion, the presented transjugular ra-pa-ECLS-technique demonstrates a less invasive method for right heart unloading with a percutaneously installed right heart assist device for short term support. Our results show the feasibility of the method indicate that a simultaneous implantation of a right heart bypass during a LVAD implantation in patients at risk for right heart failure leads to good results by means of survival.