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Combined Therapy of Ventricular Assist Device and Extracorporeal Membrane Oxygenation for Profound Acute Cardiopulmonary Failure.

Fujita, Kevin BS; Takeda, Koji MD PhD; Li, Boyganzi PhD; Mauro, Christine PhD; Kurlansky, Paul MD; Sreekanth, Sowmyashree MD; Han, Jiho BS; Truby, Lauren K. MD; Garan, Reshad MD; Topkara, Veli MD; Yuzefpolskaya, Melana MD; Colombo, Paolo MD; Naka, Yoshifumi MD PhD; Takayama, Hiroo MD PhD
doi: 10.1097/MAT.0000000000000563
Original Article: PDF Only

Short-term ventricular assist devices (ST-VAD) have been effective in treating patients with refractory cardiogenic shock. Membrane oxygenators (MO) can be added to the circuit for concomitant profound refractory hypoxia. This study reports outcomes of combined therapy in this portion of patients. This is a retrospective review of 166 patients who received an ST-biventricular assist device (BiVAD) or right ventricular assist device (RVAD) for cardiogenic shock between November 2007 and November 2014. An MO was added to the RVAD for profound hypoxia refractory to maximized ventilation. Patients were divided into two groups: 33 with (MV (MO-VAD)) and 133 without (VO (VAD only)) an MO. Survival to discharge and adverse events were compared between groups. More MV than VO patients were intubated (93.9% vs. 59.4%, p<0.001) and on VA-ECMO (72.7% vs. 19.5%, p<0.001) prior to implantation. Survival-to-discharge (51.5% MV vs. 52.6% VO, p=0.515) and 1-year survival (54.4% MV vs. 48.6% VO, p=0.955) were not significantly different. MV patients had more prolonged intubation (69.7% vs. 37.6%, p<0.001), tracheostomies (39.4% vs. 16.5%, p=0.008), and a higher risk for bleeding (p=0.037). Patients suffering from cardiogenic shock with refractory hypoxia requiring combined ST-VAD and MO therapy appear to achieve similar mid-term survival despite increased risk for early complications.

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