Impact of extra-corporeal life support (ECLS) cannulation strategy on outcome after durable mechanical circulation support system implantation on behalf of durable MCS after ECLS Study Group

Diyar Saeed*, Evgenij Potapov, Antonio Loforte, Michiel Morshuis, David Schibilsky, Daniel Zimpfer, Julia Riebandt, Federico Pappalardo, Matteo Attisani, Mauro Rinaldi, Davide Pacini, Assad Haneya, Faiz Ramjankhan, Dirk W. Donker, Ulrich P. Jorde, Wolfgang Otto, Julia Stein, Dmytro Tsyganenko, Ameen Al-Naamani, Radi WielochRafael Ayala, Jochen Cremer, Michael Borger, Artur Lichtenberg, Jan Gummert

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: The literature on outcomes of patients requiring durable mechanical circulatory support (MCS) after extra-corporeal life support (ECLS) is limited. The aim of this study was to investigate the impact of preoperative ECLS cannulation on postoperative outcome after durable MCS implantation. Methods: The durable MCS after ECLS registry is a multicenter retrospective study that gathered data on consecutive patients who underwent durable MCS implantation after ECLS between January 2010 and August 2018 in eleven high volume European centers. Patients who underwent the implantation of total artificial heart, pulsatile pumps, or first-generation pumps after ECLS were excluded from the analysis. The remaining patients were divided into two groups; central ECLS group (cECLS) and peripheral ECLS group (pECLS). A 1:1 propensity score analysis was performed to identify two matched groups. The outcome of these two groups was compared. Results: A total of 531 durable MCS after ECLS were implanted during this period. The ECLS cannulation site was peripheral in 87% (n=462) and central in 13% (n=69) of the patients. After excluding pulsatile pumps and total artificial heart patients, a total of 494 patients remained (pECLS =434 patients, cECLS =60 patients). A 1:1 propensity score analysis resulted in 2 matched groups (each 55 patients) with median age of 54 years (48-60 years) in cECLS group and 54 years (43-60 years) in pECLS group. HeartWare HVAD (Medtronic, Minneapolis, MN) was implanted in the majority of the patients (cECLS =71% vs. pECLS =76%, P=0.67). All postoperative morbidities were comparable between the groups. The thirty-day, one year and long-term survival was comparable between the groups (P=0.73). Conclusions: The cannulation strategy of ECLS appears to have no impact on the post-operative outcome after durable MCS implantation.

Original languageEnglish
Pages (from-to)353-363
Number of pages11
JournalAnnals of Cardiothoracic Surgery
Volume10
Issue number3
DOIs
Publication statusPublished - May 2021
Externally publishedYes

Keywords

  • cannulation strategy
  • extra-corporeal life support (ECLS)
  • Mechanical circulatory support (MCS)
  • outcome
  • ventricular assist device

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