Outcome evaluation of the bridge-to-bridge concept in patients with cardiogenic shock.
BACKGROUND
Patients with cardiogenic shock can be stabilized by percutaneous implantation of extracorporeal membrane oxygenation (ECMO). If weaning from ECMO is impossible, the implantation of a ventricular assist device (VAD) is required. Patients either go for recovery of myocardial function (bridge to recovery) or for heart transplantation (bridge to transplant).


METHODS
One hundred thirty-one patients were supported with ECMO between March 1995 and November 2005. Reasons for ECMO implantation were acute heart failure, acute or chronic heart failure, and postcardiotomy heart failure. In 28 patients, subsequent VAD implantation was necessary (bridge to bridge concept).


RESULTS
Fourteen bridge to bridge patients (50%) became long-time survivors with a mean follow-up of 39 months. Risk factors for mortality were status post-cardiopulmonary resuscitation and elevated lactate and bilirubin levels before VAD implantation. Complications after ECMO and VAD implantation were bleeding and thromboembolic events. The most common cause of death was multiorgan failure.


CONCLUSIONS
Bridge to bridge is a successful concept for selected patients with cardiogenic shock. During ECMO support, patients can be evaluated for comorbidities. For patients with a combination of risk factors (status post-cardiopulmonary resuscitation, elevated lactate levels, and impaired liver function), VAD implantation should be considered very carefully.
Hoefer
Daniel
D
Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. daniel.hoefer@uibk.ac.at
Ruttmann
Elfriede
E
Poelzl
Gerhard
G
Kilo
Juliane
J
Hoermann
Christoph
C
Margreiter
Raimund
R
Laufer
Guenther
G
Antretter
Herwig
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery / Q000628:therapy; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome; D014850:Waiting Lists