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EC-VAD

Combined Use of Extracorporeal Membrane Oxygenation and Percutaneous Microaxial Pump Left Ventricular Assist Device

Akanni, Olutosin J.*; Takeda, Koji*; Truby, Lauren K.; Kurlansky, Paul A.*; Chiuzan, Codruta; Han, Jiho*; Topkara, Veli K.; Yuzefpolskaya, Melana; Colombo, Paolo C.; Karmpaliotis, Dimitrios; Moses, Jeffery W.; Naka, Yoshifumi*; Garan, A. Reshad; Kirtane, Ajay J.; Takayama, Hiroo*

doi: 10.1097/MAT.0000000000000804
Adult Circulatory Support
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Combination of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and a percutaneous microaxial left ventricular assist device (pLVAD), or “EC-VAD,” has been reported in cases of left ventricular decompression with mixed results. We conducted a retrospective review of patients who received EC-VAD (n = 29) or isolated VA-ECMO therapy (ECMO-only; n = 196) for refractory cardiogenic shock between February 2011 and October 2014. Fourteen patients received VA-ECMO and then Impella pLVAD (E→EC-VAD), and 15 received the Impella pump then VA-ECMO (I→EC-VAD). E→EC-VAD patients demonstrated decreased pulmonary artery systolic (36.00 ± 16.84 mm Hg versus 30.63 ± 12.13 mm Hg; p = 0.049) and diastolic (24.25 ± 13.45 mm Hg versus 17.25 ± 7.96 mm Hg, p = 0.049) pressures by 24 hours post-EC-VAD implant. In the same period, I→EC-VAD patients demonstrated improved SvO2 (43.14 ± 16.75% versus 75.18 ± 13.88%, p = 0.043) and PaO2/FiO2 ratio (148.55 ± 67.69 mm Hg versus 374.51 ± 170.97 mm Hg, p = 0.043). Thirty-day survival rates were 42.9% in E→EC-VAD, 46.7% in I→EC-VAD, and 49.0% in ECMO-only (p = 0.913). Hemolysis occurred more in EC-VAD patients (44.83% versus 17.35% in ECMO-only, p = 0.002); however, there was no increased frequency of other adverse events including bleeding and lower limb ischemia. Despite increased hemolysis, combined use of VA-ECMO and pLVAD may improve or circumvent left ventricular distension in refractory cardiogenic shock while promoting adequate blood flow.

From the *Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York

Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York

Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York.

Submitted for consideration March 2017; accepted for publication in revised form February 2018.

Disclosure: This study was not funded. Dr. Naka receives consultant fees from Thoratec. The other authors report no conflicts.

Correspondence: Hiroo Takayama, Department of Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, New York, NY 10032. E-mail: ht2225@cumc.columbia.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs