title: Extracorporeal life support prior to left ventricular assist device implantation leads to improvement of the patients INTERMACS levels and outcome.
abstract: BACKGROUND
  The objective of this study was to evaluate the outcome of left ventricular assist device (LVAD) implantation after initial extracorporeal life support (ECLS) in patients with cardiogenic shock and the incidence of post implantation right ventricular failure.
  
  
  RESULTS
  All patients on ECLS therapy for cardiogenic shock prior to LVAD implantation (n = 15) between October 2011 and January 2014 were analyzed. Baseline patient characteristics, as well as detailed pre-operative treatment and postoperative outcome data were collected retrospectively. At time of admission to our unit all patients were classified INTERMACS II or higher (12 [80%] INTERMACS I). Improvement to INTERMACS III temporary cardiac support (TCS) at time of LVAD implantation was successful in 14 patients (93.3%). End-organ function recovered during ECLS support. No patient needed ongoing ECLS or additional right ventricular support after LVAD implantation. Both in-hospital and 30-day mortality was 6.7% (n = 1). The median duration of LVAD support was 687.9 ± 374.5 days. At the end of the study (follow-up 810.7 +/- 338.9 days), 13 (86.7%) patients were alive. The majority of patients (10 [66.7%]) remained on LVAD support. Transplantation could be performed in 1 (6.7%) patient, 2 (13.3%) patients could be successfully weaned.
  
  
  CONCLUSIONS
  LVAD implantation in ECLS patients leads to improvement of INTERMACS level to INTERMACS III TCS status. Excellent mid-term survival comparable to true INTERMACS III-IV patients could be shown. ECLS prior to LVAD as a bridge-to-bridge therapy may help to lower mortality in primarily unstable patients.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Schibilsky
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany.
authors.forename: Christoph
authors.identifier: http://orcid.org/0000-0002-9716-8197
authors.initials: C
authors.lastname: Haller
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lange
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Schibilsky
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Medical Center Tuebingen, Tuebingen, Germany.
authors.forename: Helene
authors.initials: H
authors.lastname: Haeberle
authors.affiliation: Department of Cardiology, University Medical Center Tuebingen, Tuebingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Seizer
authors.affiliation: Department of Cardiology, University Medical Center Tuebingen, Tuebingen, Germany.
authors.forename: Meinrad
authors.initials: M
authors.lastname: Gawaz
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Medical Center Tuebingen, Tuebingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Rosenberger
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Walker
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schlensak
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D055815:Young Adult