title: Impact of preoperative percutaneous cardiopulmonary support on outcome following left ventricular assist device implantation.
abstract: BACKGROUND
  The purpose of the present study was to determine the impact of preoperative percutaneous cardiopulmonary support (PCPS) on long-term survival following implantation of a left ventricular assist device (LVAD).
  
  
  RESULTS
  Between 1999 and 2010, we used implantable (n=12) and paracorporeal (n=91) LVADs in 103 consecutive cardiomyopathy patients as a bridge to transplantation. Prior to LVAD implantation, all patients received inotropes, and 25 patients (24%) received PCPS because of cardiogenic shock. Postoperatively, there were no early mortalities within 30 days after surgery, and patients survived on LVAD for 560±391 days, of whom 9 patients recovered and 32 underwent heart transplantation after 711±360 days of LVAD support. More patients with preoperative PCPS required nitric oxide inhalation and prolonged inotropic support to maintain adequate LVAD flow. In addition, bilirubin level at 1 month after LVAD implantation was significantly higher in patients with preoperative PCPS. Cox regression analysis identified preoperative PCPS support as the only significant predictor for death after LVAD implantation and overall survival was significantly better in patients without preoperative PCPS.
  
  
  CONCLUSIONS
  Despite adequate hemodynamic support after LVAD implantation, patients with preoperative PCPS had significantly worse survival. LVAD should be used for patients with end-stage heart failure, before PCPS is required for hemodynamic support.
authors.affiliation: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan. ktoda2002@yahoo.co.jp
authors.forename: Koichi
authors.initials: K
authors.lastname: Toda
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujita
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shimahara
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kitamura
authors.forename: Osamu
authors.initials: O
authors.lastname: Seguchi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Murata
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yanase
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatani
mesh_terms: D001663:Bilirubin / Q000097:blood; D009202:Cardiomyopathies / Q000401:mortality / Q000601:surgery*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D005260:Female; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010107:Oxygenators, Membrane / Q000009:adverse effects; D057234:Preoperative Period; D012044:Regression Analysis; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000517:prevention & control*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D001663:Bilirubin