Outcomes in Patients Bridged to HeartMate 3 LVAD Using VA-ECMO

Purpose: Implantation of short-term mechanical circulatory support (MCS) devices as a bridge-to-decision has been gaining popularity. However, outcomes using ECMO as a bridge to LVAD implantation have not been well studied. The aim of this study was to analyze our single-center experience with patients who underwent ECMO support as a bridge to HeartMate 3 LVADs.

Methods: From January 2016 through February 2021, 102 patients with chronic heart failure underwent implantation of an HM3 LVAD. we studied 17 Patients bridged with ECMO regarding pre-operative demographics, postoperative complications, and long-term survival and In addition, we compared them to our patients who underwent implantation of LVAD without an ECMO bridge.

Results: 17 patients underwent LVAD implantation from ECMO bridging. The mean age was 59±14 years, mean ejection fraction was 12±8%.

Survival at 30 days, 6 months, and a year was 70.6%, 58.8%, and 53% respectively.

Incidence of bleeding requiring re-exploration, stroke, and RV failure were 35%, 17.6%, and 0% respectively.

When comparing the ECMO group to the LVAD group, the ECMO group had a lower Ejection Fraction (12±8% vs. 18±7%, p<0.015) and were in a worse metabolic status with lower albumin, hemoglobin, and higher urea respectively (2.8±0.7 vs. 3.8±0.5, p<0.001; 8.9±0.5 vs. 12.3±1.3, p<0.010; 135±35 vs. 75±47, p<0.079).

Postoperative, in the ECMO group there were more incidence of bleeding , stroke and tracheostomy respectively (35.3% vs. 13%, p<0.001; 17.6% vs. 7%, p<0.152; 64.7% vs. 7%, p<0.001). Time of ICU hours, ventilation, and Hospitalization days were higher as well respectively (641±280 vs. 141±206, p<0.001; 496±238 vs. 72±174, p<0.001; 48±29 vs. 21±25, p<0.001).

Conclusions: For patients bridged to LVAD using ECMO, there is high morbidity and mortality in the immediate postoperative period. However, these patients have close to 100% mortality without LVAD. Therefore, this strategy of stabilizing an INTERMACS 1 patient with ECMO and then proceeding to LVAD implantation is warranted.