OC31 HOW TO IDENTIFY THE APPROPRIATE LEFT VENTRICULAR ASSIST DEVICE CANDIDATE AMONG PATIENTS ON EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT

Abstract

Background and Aim: Implantation of long-term left ventricular assist devices (LVADs) in patients on veno-arterial membrane oxygenation (VA-ECMO) support is controversial. Aim of this study has been to report the experience of seven LVAD centers. Methods: Data of LVAD patients (2010–2017) at seven European institutions were reviewed. The only inclusion criteria was VA-ECMO before LVAD placement. Patients’ characteristics, intraoperative variables and postoperative course were analyzed thus eventually identifying predictors of mortality. Results: A total of 154 continuous flow LVAD patients (mean age 53.1 ± 12 years; 84% male) were identified. The VA-ECMO cannulation was peripheral in 92% of patients and 37% had received cardiopulmonary resuscitation prior to VA-ECMO implantation. Mean VA-ECMO duration prior to LVAD implantation was 7.1 ± 7 days. Cardiopulmonary bypass was adopted in 64% of patients for LVAD implantation. Major postoperative complications included right heart failure requiring temporary right ventricular device (RVAD) support (47%), bleeding requiring rethoracotomy (20%), respiratory failure (54%), renal failure (50%) and hepatic failure (31%). Thirty-day and 1-year survival was 84 and 62%, respectively. At univariate analysis age, lactate level, pH, white blood cells (WBC) count, pre-LVAD dialysis and Model for End-stage Liver Disease eXcluding INR (MELD-XI) score before implant were significant. Multivariate regression analysis identified pre-LVAD MELD-XI (OR 1,250, 95% CI 1,038–1,505; p = 0.019) as the only significant predictor of mortality. Conclusions: The outcome of LVAD patients on VA-ECMO support is limited by the high rate of major adverse events. Preoperative LVAD MELD-XI score seems to identify patients that will clearly not benefit from LVAD implantation.