title: Extracorporeal Life Support Bridge to Ventricular Assist Device: The Double Bridge Strategy.
abstract: In patients requiring left ventricular assist device (LVAD) support, it can be difficult to ascertain suitability for long-term mechanical support with LVAD and eventual transplantation. LVAD implantation in a shocked patient is associated with increased morbidity and mortality. Interest is growing in the utilization of extracorporeal life support (ECLS) as a bridge-to-bridge support for these critically unwell patients. Here, we reviewed our experience with ECLS double bridging. We hypothesized that ECLS double bridging would stabilize end-organ dysfunction and reduce ventricular assist device (VAD) implant perioperative mortality. We conducted a retrospective review of prospectively collected data for 58 consecutive patients implanted with a continuous-flow LVAD between January 2010 and December 2013 at The Alfred Hospital, Melbourne, Victoria, Australia. Twenty-three patients required ECLS support pre-LVAD while 35 patients underwent LVAD implantation without an ECLS bridge. Preoperative morbidity in the ECLS bridge group was reflected by increased postoperative intensive care duration, blood loss, blood product use, and postoperative renal failure, but without negative impact upon survival when compared with the no ECLS group. ECLS stabilization improved end-organ function pre-VAD implant with significant improvements in hepatic and renal dysfunction. This series demonstrates that the use of ECLS bridge to VAD stabilizes end-organ dysfunction and reduces VAD implant perioperative mortality from that traditionally reported in these "crash and burn" patients.
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Prahran, Victoria, Australia.|Department of Surgery, The Alfred Hospital, Prahran, Victoria, Australia.
authors.forename: Silvana F
authors.initials: SF
authors.lastname: Marasco
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Prahran, Victoria, Australia.|Department of Surgery, The Alfred Hospital, Prahran, Victoria, Australia.
authors.forename: Casey
authors.initials: C
authors.lastname: Lo
authors.affiliation: Intensive Care Unit, The Alfred Hospital, Prahran, Victoria, Australia.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Murphy
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Prahran, Victoria, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Summerhayes
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Prahran, Victoria, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Quayle
authors.affiliation: Department of Cardiothoracic Surgery, The Alfred Hospital, Prahran, Victoria, Australia.|Department of Surgery, The Alfred Hospital, Prahran, Victoria, Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: Zimmet
authors.affiliation: Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010107:Oxygenators, Membrane; D011474:Prosthesis Design; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D014739:Victoria
keywords: Biventricular assist device; Bridge-to-bridge; Extracorporeal life support; Extracorporeal membrane oxygenation; Heart failure; Left ventricular assist device; Right ventricular assist device; Shock; Total artificial heart