Thorac Cardiovasc Surg 2019; 67(S 01): S1-S100
DOI: 10.1055/s-0039-1678887
Oral Presentations
Monday, February 18, 2019
DGTHG: Kurzzeitige Herz - Kreislaufunterstützung
Georg Thieme Verlag KG Stuttgart · New York

Left Ventricular Assist Devise Implantation after Extracorporeal Membrane Oxygenation Therapy and Subsequent Impella 5.0 Therapy—A Multicenter Analysis

F. Pappalardo
1   DGTHG-Vita Salute San Raffaele University, Advanced Heart Failure and MCS Program, Milan, Italy
,
L. Bertoldi
1   DGTHG-Vita Salute San Raffaele University, Advanced Heart Failure and MCS Program, Milan, Italy
,
H. Reichenspurner
2   Universitäres Herzzentrum Hamburg, Herz- und Gefäßchirurgie, Hamburg, Germany
,
A. Bernhardt
2   Universitäres Herzzentrum Hamburg, Herz- und Gefäßchirurgie, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
28 January 2019 (online)

 
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    Background: Left ventricular assist device (LVAD) therapy in INTERMACS I and II patients is associated with lower outcome compared to stable patients. Often an arterial–venous extracorporeal membrane oxygenation (ECMO) therapy is implanted to stabilize patients first and improve end-organ function. But, ECMO therapy itself is associated with complications such as thromboembolism and bleeding. Therefore, an Impella 5.0 device is implanted to avoid these complications and unload the left ventricle. We here report the multicenter experience in patients after change from ECMO to Impella 5.0 therapy with subsequent LVAD implantation.

    Methods: We retrospectively evaluated nine patients in two European centers after ECMO, Impella 5.0 and subsequent LVAD implantation. Mean age was 53.0 ± 6.2 years and 8 (88.9%) were male. ECMO was placed for acute myocardial infarction in seven patients (77.8%) and eight patients (88.9%) were resuscitated. Median follow-up was 227 days (range: 127–380).

    Results: Median time on ECMO before Impella 5.0 implantation was 8 (range: 4–14) days. The ECMO was weaned over a median of 22 hours (0–72) in successful in all patients. Eight patients (88.9%) were mobilized while on Impella support. Total median time on Impella 5.0 was 17 (range: 12–21) days. Two patients underwent LVAD implantation as a re-do operation. Seven patients (77.8%) underwent Medtronic HVAD and two patients (22.2%) Abbott HeartMate 3 implantation. One patient (11.1%) experienced RV failure requiring temporary RVAD implantation. A 30-day survival was 100%. During follow-up, one patient was transplanted after 8 days. One patient died after 380 days. All other patients are still on device.

    Conclusion: Change from ECMO to Impella 5.0 therapy before LVAD implantation allowed LV unloading, end-organ recovery, and assessment of the right ventricular function. Excellent survival was seen in this small patient cohort. This promising approach should be evaluated in larger patient series.


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    No conflict of interest has been declared by the author(s).

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