title: Extracorporeal life support as a bridge to bridge: a strategy to optimize ventricular assist device results.
abstract: OBJECTIVE
  Extracorporeal life support (ECLS) devices provide temporary mechanical circulatory assistance and are usually implanted under emergency conditions in critical patients. If weaning off ECLS is not possible, heart transplantation or implantation of long-term mechanical circulatory support (LTMCS) is required. The purpose of our study was to evaluate the bridge-to-bridge (BTB) concept.
  
  
  METHODS
  Between 1 January 2004 and 1 August 2010, 97 patients were assisted by LTMCS. The implantation was the first-line intervention in 48 patients (the bridge group), and was performed after a period of ECLS support in 49 others (the BTB group).
  
  
  RESULTS
  The long-term survival rate was 51.6%, with a mean follow-up of 30.7 months, and there were no differences for biological parameters between the two groups. Patients in the BTB group whose condition was initially more severe, improved under ECLS support, and those in whom biological parameters did not revert to normal died after LTMCS. Risk factors for mortality in the BTB group were total bilirubin and lactate before LTMCS, and alkaline phosphatase before ECLS support.
  
  
  CONCLUSIONS
  The BTB concept allows the implementation of LTMCS in severe patients, for whom it was not originally envisaged, with the same long-term survival as in first-line settings. ECLS in the evolution of patients is predictive of survival after LTMCS.
authors.affiliation: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University 'Pierre et Marie Curie', Paris, France guillaume.lebreton@psl.aphp.fr guillaumelebreton@live.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lebreton
authors.affiliation: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University 'Pierre et Marie Curie', Paris, France School in Cardiovascular Science, Cardiovascular Surgery Unit, University of Verona Medical School, Verona, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Pozzi
authors.affiliation: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University 'Pierre et Marie Curie', Paris, France.
authors.forename: Ciro
authors.initials: C
authors.lastname: Mastroianni
authors.affiliation: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University 'Pierre et Marie Curie', Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Léger
authors.affiliation: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University 'Pierre et Marie Curie', Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Pavie
authors.affiliation: Division of Cardiac Surgery, Pitié-Salpêtrière Hospital, University 'Pierre et Marie Curie', Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005112:Extracorporeal Circulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult
keywords: Extracorporeal circulation; Extracorporeal life support; Heart failure; Heart-assist device; Prognosis