Journal of Heart and Lung Transplantation | 2021
Bridge from Central Extracorporeal Life Support to Durable LVAD in Acute Heart Failure Elevates a Risk of Stroke Long-Term
Abstract
Purpose Central extracorporeal life support (ECLS) has been shown to yield a sufficient flow support with unloading of heart and lung in cases having acute refractory heart failure with durable LVAD candidacy being uncertain. In contrast, subsequent implantation of durable LVAD after the bridge by the central ECLS is reportedly associated with morbidities in-hospital and long-term. This study aimed to review outcomes of this bridge strategy from central ECLS to durable LVAD, as compared to those of primary LVAD implantation. Methods This study enrolled an institutional consecutive series of 158 cases who underwent durable LVAD implantation from April 2013 to September 2020. Of these, 43 cases (27%), who were bridged from central ECLS, were compared with 115 cases (73%) who underwent primary durable LVAD implantation. Results The mean age was 45.2±12.2 years and 111 cases were male. Durable LVAD included HeartMateII 120 cases, HeartMate3 in 38 cases. Before the durable LVAD implantation, there were significant intergroup differences in systolic diameter of the LV (Bridge; 51.7±2.0 vs Primary; 65.0±1.2 mm, p Conclusion The bridge strategy yielded similar midterm outcomes as compared to the primary strategy, apart from stroke incidence which was more prominent after the bridge strategy. Perioperative care for bleeding potentials may protect from stroke after the bridge strategy.