Differences in Post-Thoracotomy Outcomes in Patients Implanted off ECMO

• Published in: The Journal of heart and lung transplantation Vol. 38; no. 4; pp. S175 - S176
• Main Authors: Schmitto, J.D., Ozbaran, M., Engin, C., Simon, A., Horvath, V., Roussel, J., Pac, M., Kervan, U., Klotz, S., Wagner, F., Schloeglhofer, T., Zimpfer, D.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2019
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2019.01.421

There is a growing trend toward the use of less invasive, non-sternotomy approaches in all fields of cardiac surgery, including implantation of left ventricular assist devices (LVADs). The less invasive, thoracotomy procedure has been successfully used worldwide, with an estimated 25% of implants performed internationally using this approach. This approach is also used more frequently in varying patient populations, including those coming into the procedure on ECMO. With the new UNOS transplant listing criteria, ECMO use may change, and understanding the impact on subsequent procedures in this population is of increasingly important. We present here a comparison of outcomes of HVAD implants by a thoracotomy approach in patients either on or off ECMO at baseline. This Retrospectively analysis of clinical data and outcomes of 281 patients implanted with the HVAD Pump via a thoracotomy approach at high volume thoracotomy implanting centers in Europe in a real-world setting. Implants were performed both on and off pump, and with standard and alternative outflow graft locations. Patients were implanted directly from ECMO in 17%. Compared to patients implanted with an HVAD without baseline ECMO, those implanted directly from ECMO experienced a higher rate of bleeding events (0.30 vs. 0.11 events per patient year (EPPY), p value = 0.02, respectively), more renal dysfunction (0.19 vs. 0.05 EPPY, p value = 0.03) and a trend toward few cardiac arrythmias (0.19 vs. 0.07 EPPY, p value = 0.08). Overall survival at one year post implant was 81% in the non-ECMO thoracotomy group, compared to 56% in the group implanted directly from ECMO (p value = 0.0003). The analysis of real world use of the HVAD implanted using a thoracotomy approach demonstrates that there is significantly worse survival and adverse event profile in patients undergoing implants off ECMO. However, these results do not appear to be worse than previous reports of LVAD implants off ECMO via a sternotomy approach.