title: Primary extracorporeal membrane oxygenation versus primary ventricular assist device implantation in low cardiac output syndrome following cardiac operation.
abstract: Mechanical support is often the only therapeutic option in low cardiac output (LCO) following cardiac operation using extracorporeal circulation (ECC). However, the question whether primary ventricular assist device (VAD) or primary extracorporeal membrane oxygenation (ECMO) followed by secondary VAD implantation is superior remains unclear. We analyzed the outcome of 183 patients with LCO following ECC. Primary VAD implantation (VAD) was performed on 20 patients and 163 patients underwent ECMO implantation (ECMO). Out of this group, 13 patients received a secondary VAD (ECMO-VAD). Age was significantly lower in the VAD group, while gender and type of operation were similarly distributed. Thirty-day mortalities were 50, 75, and 46% (VAD, ECMO, and ECMO-VAD, respectively; P < 0.05 ECMO vs. VAD and ECMO-VAD). Survival was best with VAD implantation 1.2 +/- 1.2 days following LCO. In conclusion, the outcome of LCO following ECC remains poor. Early VAD support provides best survival. Primary or secondary VAD implantation has no impact on survival.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Muenster, Germany. stefan.klotz@ukmuenster.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Klotz
authors.forename: Andreas
authors.initials: A
authors.lastname: Rukosujew
authors.forename: Henryk
authors.initials: H
authors.lastname: Welp
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.forename: Tonny D T
authors.initials: TD
authors.lastname: Tjan
authors.forename: Hans H
authors.initials: HH
authors.lastname: Scheld
mesh_terms: D000328:Adult; D002303:Cardiac Output, Low / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000379:methods; D005112:Extracorporeal Circulation / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome