Improved survival of INTERMACS 1 patients with ECMO-support before assist device implantation

Objective: We aimed to analyse how preoperative extracorporeal membrane oxygenation-(ECMO)-therapy is affecting the survival rate for VAD implantations of INTERMACS-I-patients suffering from end-stage heart failure.

Methods: We retrospectively analysed the data of more than 200 VAD patients of which 38 received preoperative ECMO-support. The indication for ECMO was acute cardiac failure with the need for high dosage catecholamines. Endpoints were: death after implantation before discharge, transplanted after assist device implantation, LVAD explantation and ongoing (patients waiting for transplantation or undergoing treatment as destination therapy). All data were collected from HMS database.

Results: In 38 patients ECMO-therapy was performed before VAD implantation in high risk heart-failure patients. Mean age of the male patient population was 52 years (n = 26) respectively 44 years in female patients (n = 12). The mean preoperative duration of ECMO support was 5 days. 28 of 38 patients survived 30-days after implantation, 73.7%, however 10 died with a mean survival of 13 days. Four patients underwent cardiac transplantation. One patient could be explanted after recovery. 14 Patients are still on ongoing support. Before initial discharge.7 more patients died (14 male, 3 female) and a total of 16 out of 38 patients survived for more than 180 days leading to a 0.5-year survival rate of 42.1% in this INTERMACS-I-high-risk group.

Conclusion: ECMO-support before LVAD-implantation is still combined with high perioperative mortality rates. Our results suggest an increased 30-dsy as well as 0.5.year survival rate compared to calculated 180-day-survival probability of 27% in INTERMACS-I-patients which are described in literature. The presented results may be caused by technical improvements of the devices during the past years, increased surgical.