Abstract
The purpose of this study was to elucidate the difference in inotrope use between patients who underwent left ventricular assist device (LVAD) implantation with preoperative extracorporeal membrane oxygenation (ECMO) and those who underwent LVAD implantation without preoperative ECMO. One hundred and eight patients who underwent LVAD implantation were enrolled in this study. Prior to LVAD implantation, 27 patients received ECMO support (ECMO group) and the other 81 patients did not (non-ECMO group). Cardiac index (CI), mean arterial pressure (MAP), mixed venous oxygen saturation (SvO2), and the vasoactive inotropic score (VIS) were recorded at weaning from cardiopulmonary bypass (CPB), 30 min after weaning from CPB (min after CPB), 60 min after CPB, and at the end of surgery. MAP and VIS were also recorded before induction of anesthesia (baseline). The modified VIS was defined as: (dopamine µg/kg/min × 1 + dobutamine µg/kg/min × 1 + epinephrine µg/kg/min × 100 + noradrenaline µg/kg/min × 100 + milrinone µg/kg/min × 10 + olprinone µg/kg/min × 25). There were no significant differences between the ECMO group and the non-ECMO group in terms of hemodynamic parameters such as MAP, CI, and SvO2. However, the ECMO group had higher VIS and noradrenaline doses than that of non-ECMO group (p = 0.030 and p = 0.044, respectively). VIS was significantly higher in ECMO group at 30 min after CPB (p = 0.03), 60 min after CPB (p = 0.003), and at the end of the surgery (p < 0.001). The doses of noradrenaline were significantly higher in ECMO group at 60 min after CPB (p = 0.013), and at the end of surgery (p = 0.002). Patients who received ECMO support prior to LVAD implantation required significantly more noradrenaline to maintain normal levels of hemodynamic parameters compared with patients without ECMO.
Highlights
Mechanical circulatory support with left ventricular assist devices (LVADs) is becoming increasingly important as a therapeutic intervention for patients with advanced heart failure recalcitrant to medical therapy
We retrospectively investigated 108 patients with advanced heart failure who underwent LVAD implantation as a bridge to heart transplantation at the National Cerebral and Cardiovascular Center between May 1999 and September 2011
White blood cell count and C-reactive protein levels before LVAD implantation were significantly higher in the Extracorporeal membrane oxygenation (ECMO) group
Summary
Mechanical circulatory support with left ventricular assist devices (LVADs) is becoming increasingly important as a therapeutic intervention for patients with advanced heart failure recalcitrant to medical therapy. It is important to set up patients eligible for transplantation with appropriate hemodynamic support without delay; otherwise death or serious morbidity may occur. Several risk factors have been identified in regard to mortality after LVAD implantation (Holman et al 2009; Rao et al 2003). One of the most significant risk factors is preoperative cardiogenic shock. Extracorporeal membrane oxygenation (ECMO) is often used to improve and stabilize the preoperative condition of LVAD patients. ECMO support prior to LVAD implantation has recently been reported to significantly worsen survival rates (Toda et al 2012). We hypothesized that patients who receive ECMO support prior to LVAD implantation need higher doses of inotropes than
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