Left ventricular assist device implantation with ECMO support instead of cardiopulmonary bypass

Aims: Replacing cardiopulmonary bypass (CPB) with ECMO for isolated ventricular assist device (LVAD) implantation has significant theoretical advantages, including less systemic inflammation and bleeding disorders. We evaluate whether LVAD implantation with ECMO is feasible and safe. Methods and patients: From September 2011 to September 2012 38 patients (mean age 57 ± 13, sex male 79%) with terminal heart failure underwent LVAD implantation (28 Heartware HVAD and 10 Thoratec Heart Mate II) at our department. Circulatory support for LVAD implantation was performed with cardiopulmonary bypass in 21 patients and ECMO in 17 patients. Results: Patients in the ECMO group were more likely to be in an advanced intermacs level (ECMO mean intermacs level 1.7 ± 1.1, CPB mean intermacs level 2.6 ± 1.1, p = 0.003). No conversions from ECMO to CPB were observed. Thirty day mortality (ECMO 5.9%, CPB 9.5%, p = 0.679) and in-hospital mortality (ECMO 5.9%, CPB 14.3%, p = 0.401) were comparable between the two groups. No difference was observed in the incidence of postoperative adverse events including revision for surgical bleeding (ECMO 5.8% vs. CPB 0%, p = 0.260) as well as duration of ICU (ECMO mean 17 ± 15 days vs. CPB mean 18 ± 28 days, p = 0.298) and in hospital stay (ECMO mean 36 ± 33 days vs. CPB mean 29 ± 30 days, p = 0.198). Conclusion: Isolated left ventricular assist device implantation with ECMO instead of cardiopulmonary bypass is feasible and safe. Therefore, a broader use of this technique is justified in order to clarify if the theoretical advantages of ECMO result in improved clinical outcomes.