title: Left Ventricular Unloading by Impella Device Versus Surgical Vent During Extracorporeal Life Support.
abstract: BACKGROUND
  Patients supported with extracorporeal life support (ECLS) can experience severe complications from increased left ventricular (LV) afterload. The Impella (Abiomed, Danvers, MA) percutaneous ventricular assist device (PVAD) may offer an attractive option for unloading the LV in these patients. This study describes the efficacy and outcomes of PVAD use during ECLS compared with surgically placed LV vent.
  
  
  METHODS
  In this retrospective study, we reviewed patients supported by ECLS with PVAD or surgical LV vent for cardiogenic shock between April 2010 and May 2016. Included were 23 patients with PVADs and 22 with surgical vents. Patients' baseline characteristics, hemodynamic data, and outcomes were collected immediately preceding combined support initiation, at 48 hours, intensive care unit discharge, and 30 days.
  
  
  RESULTS
  After 48 hours, pulmonary artery diastolic pressure was significantly reduced in the PVAD (23.3 ± 8.4 vs 15.6 ± 4.2, p = 0.02) and surgical vent groups (20.1 ± 5.9 vs 15.6 ± 5.4, p = 0.01), and radiographic evidence of pulmonary edema was reduced or unchanged in 90% of PVAD patients and in 76% of surgical vent patients. The primary end points of survival to 30 days (43% vs 32%, p = 0.42) and intensive care unit discharge (35% vs 23%, p = 0.37) were not different between the two methods of support. The PVAD and surgical vent groups were also not significantly different in the rate of vascular complications or in the number decannulated from ECLS and transitioned to durable LV assist device.
  
  
  CONCLUSIONS
  PVAD use in ECLS patients is an effective means of LV unloading and preventing worsened pulmonary edema, with outcomes and complications that are comparable to surgical LV vent.
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tepper
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Muhammad Faraz
authors.initials: MF
authors.lastname: Masood
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Moises
authors.initials: M
authors.lastname: Baltazar Garcia
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Molly
authors.initials: M
authors.lastname: Pisani
authors.affiliation: Division of Cardiovascular Diseases, Washington University School of Medicine in St. Louis, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Ewald
authors.affiliation: Division of Interventional Cardiology, Washington University School of Medicine in St. Louis, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: John M
authors.initials: JM
authors.lastname: Lasala
authors.affiliation: Division of Cardiovascular Diseases, Washington University School of Medicine in St. Louis, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bach
authors.affiliation: Division of Interventional Cardiology, Washington University School of Medicine in St. Louis, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Jasvindar
authors.initials: J
authors.lastname: Singh
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Keki R
authors.initials: KR
authors.lastname: Balsara
authors.affiliation: Division of Cardiothoracic Surgery, Washington University School of Medicine in St. Louis, Barnes-Jewish Hospital, St. Louis, Missouri. Electronic address: itoha@wustl.edu.
authors.forename: Akinobu
authors.initials: A
authors.lastname: Itoh
mesh_terms: D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome