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Successfully Weaned Patients after VA ECMO Due to Cardiogenic Shock: Etiology and 1-Year Survival
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The Journal of Heart and Lung Transplantation, Vol 35, No 4S, April 2016
1( 038)
The 1-year survival rate of the patients who had an aMI was 73.7% (28/38) and from the surgical patients without aMI was 80.0% (20/25) respectively. Patients with non-ischemic cardiomyopathy had a 1-year survival of 75.0% (6/8) after successful ECMO-therapy. Conclusion: The 1-year mortality of patients with cardiogenic shock, supported with VA ECMO who survived to discharge appears to be moderate. The mortality of patients with cardiogenic shock after successful VA-ECMO treatment seems not to be dependent upon the etiology of the cardiogenic shock.
Interim Results of a Phase II Clinical Trial Comparing Outcomes of Recipients of Lungs Recovered from Uncontrolled Donation After Circulatory Determination of Death Donors (uDCDDs) Assessed by Ex-Vivo Lung Perfusion (EVLP) and CT Scan to Outcomes of Recipients of Lungs from Brain-Dead Donors (BDDs) T.M. Egan ,1 B. Haithcock,1 J. Long,1 K. Birchard,2 J. Lobo,3 P. Stewart,4 J. Blackwell,1 D. Yuan,1 C. Thys,5 D. Karb,6 S. Miller,6 M. Hartwig.7 1Surgery, U. North Carolina Sch Med, Chapel Hill, NC; 2Radiology, U. North Carolina Sch Med, Chapel Hill, NC; 3Medicine, U. North Carolina Sch Med, Chapel Hill, NC; 4Biostatistics, U. North Carolina Sch Med Gillings School of Public Health, Chapel Hill, NC; 5Carolina Donor Services, Durham, NC; 6U. North Carolina Sch Med, Chapel Hill, NC; 7Surgery, Duke University School of Medicine, Durham, NC. Summary of Objectives: This clinical trial is designed to show safety and non-inferiority of lung transplant (LTX) with lungs recovered from uDCDDs evaluated by EVLP and ex-vivo CT scan compared to lungs recovered from BDDs. The study began in Sept. 2013, and is scheduled to run until June 30, 2017. Methods: Our organ procurement organization (OPO) began to seek consent for lung recovery for possible LTX from next-of-kin (NOK) of uDCDDs in one urban county. uDCDDs from 4 Emergency Departments (EDs) were added during the first year. Consented recipients at 2 LTX centers in the OPO received whichever lung became available first (uDCDD or BDD), based on blood type, LAS, and size. __ lungs were recovered from uDCDDs. ___ were assessed by EVLP and ex-vivo CT scan. ___ were judged suitable for lung transplant; ___ were transplanted. Outcomes were compared to __ transplanted with lungs recovered from BDDs. Endpoints: Primary outcome measures: Primary Graft Dysfunction (PGD) score at 72 hours and 30-day and one-year survival. Secondary outcome measures: PGD score at 24 hours; mechanical ventilation time; on ventilator or ECMO 7 days after LTX; ICU length of stay (LOS); hospital LOS; requirement for re-intubation; incidence of biopsy proven acute rejection; and incidence of bronchial complications. See Table for results. To date, lungs from 2 uDCDDs were judged suitable for transplant, but no uDCDD lungs have yet been transplanted. Data will be updated before March 23. 1( 039) Successfully Weaned Patients after VA ECMO Due to Cardiogenic Shock: Etiology and 1-Year Survival D. Pabst ,1 A. Ghodsizad,1 A. El-Banayosy,2 B. Soleimani,1 C. Brehm.1 1Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA; 2INTEGRIS Baptist Medical Center, Oklahoma City, OK. Purpose: Congestive heart failure is one of the leading causes of hospital admission in adult patients with heart disease. Patients with decompensated cardiac failure clinically present with cardiogenic shock in which a venoarterial extracorporeal membrane oxygenation (VA-ECMO) is often the final treatment option. Methods: In our institution a cohort of 155 patients received VA ECMO for cardiogenic shock between June 2008 and October 2014. 1-year survival, etiology and post-weaning process of these patients were investigated. Results: Out of 155 patients, 83 (53.6%) were able to be weaned from ECMO and were discharged. 66 (79.6%) of the 83 patients survived the first year after ECMO-treatment. 43 (51.8%) of the patients developed cardiogenic shock due to an acute myocardial infarction (aMI) or acute decompensated ischemic cardiomyopathy, of which, 9 underwent coronary artery bypass grafting (CABG) procedure prior to ECMO placement. An additional 25 (30.1%) patients underwent cardiac surgery for other reasons (7 (8.4%) valve surgery, 6 (7.2%) both valve and CABG surgeries, 4 (4.8%) elective CABG surgery, 6 (7.2%) heart transplantation, 1 (1.2%) PFO surgery and 1 (1.2%) myectomy) directly prior to or while showing signs of cardiogenic shock. 8 patients (9.6%) had a non-ischemic cardiomyopathy, 3 patients (3.6%) had a graft failure after heart transplantation and 3 (3.6%) of the patients suffered from pulmonary emboli. Furthermore 1 (1.2%) of the patients had a cardiogenic shock due to a pericardial effusion after stenting a stenosis of the superior vena cava.
1( 040) Left Ventricular Assist Device Placement with Concomitant Ventricular Reconstruction for Aneurysmal Disease J.W. Smith , J.D. Pal, D. Walters, C.M. Mahr, N.A. Mokadam. Univ of Washington, Seattle, WA. Purpose: Left ventricular aneurysms a surgical challenge in patients with advanced heart failure requiring implantation of a left ventricular assist device. We describe our institutional experience with left ventricular reconstruction at the time of LVAD implantation. Methods: The medical records of all patients who underwent LVAD implantation between January 1, 2007 and December 31, 2014 were reviewed and patients with left ventricular aneurysms were identified. Individual records were reviewed to determine perioperative and long-term outcomes. Results: During the study period, five patients were identified with left ventricular aneurysms. One patient had previously undergone a lateral wall linear resection. All five patients had technically successful LVAD implantation, four with concomitant left ventricular reconstruction. Two patients underwent ventriculoplasty with usual apical inflow cannulation. Two patients had anterior Dor procedures with incorporation of the inflow cannula site into the repair. In order to prevent thrombotic complications, aneurysms were resected and all adherent thrombus removed from the left ventricle. Bovine pericardium was used to cover the left ventricular aspect of resected muscle or septum to reduce the likelihood of thrombus formation. One patient suffered a perioperative stroke with poor neurologic recovery, and the family elected to withdraw support. Four of the five patients survived to discharge. Two patients remain on mechanical circulatory support as destination therapy, and two of the patients successfully underwent heart transplantation. Conclusion: Left ventricular aneurysm resection and reconstruction during LVAD implantation is technically feasible and may be necessary for appropriate inflow cannula position. The operative approach to left ventricular aneurysms needs to individualized for each patient’s particular anatomy, and the LVAD apical cannulation site is determined by the type of repair required.
1( 041) Left Ventricle Mechanical Circulatory Support Implantation as Successful Bridge to Transplantation for Patients with Cardiac Cachexia M. Hegarova ,1 I. Malek,1 V. Melenovsky,1 Z. Dorazilova,1 J. Kettner,1 J. Maly,2 I. Netuka,2 J. Pirk.2 1Department of Cardiology, IKEM, Prague,
The Journal of Heart and Lung Transplantation, Vol 35, No 4S, April 2016
1( 038)
The 1-year survival rate of the patients who had an aMI was 73.7% (28/38) and from the surgical patients without aMI was 80.0% (20/25) respectively. Patients with non-ischemic cardiomyopathy had a 1-year survival of 75.0% (6/8) after successful ECMO-therapy. Conclusion: The 1-year mortality of patients with cardiogenic shock, supported with VA ECMO who survived to discharge appears to be moderate. The mortality of patients with cardiogenic shock after successful VA-ECMO treatment seems not to be dependent upon the etiology of the cardiogenic shock.
Interim Results of a Phase II Clinical Trial Comparing Outcomes of Recipients of Lungs Recovered from Uncontrolled Donation After Circulatory Determination of Death Donors (uDCDDs) Assessed by Ex-Vivo Lung Perfusion (EVLP) and CT Scan to Outcomes of Recipients of Lungs from Brain-Dead Donors (BDDs) T.M. Egan ,1 B. Haithcock,1 J. Long,1 K. Birchard,2 J. Lobo,3 P. Stewart,4 J. Blackwell,1 D. Yuan,1 C. Thys,5 D. Karb,6 S. Miller,6 M. Hartwig.7 1Surgery, U. North Carolina Sch Med, Chapel Hill, NC; 2Radiology, U. North Carolina Sch Med, Chapel Hill, NC; 3Medicine, U. North Carolina Sch Med, Chapel Hill, NC; 4Biostatistics, U. North Carolina Sch Med Gillings School of Public Health, Chapel Hill, NC; 5Carolina Donor Services, Durham, NC; 6U. North Carolina Sch Med, Chapel Hill, NC; 7Surgery, Duke University School of Medicine, Durham, NC. Summary of Objectives: This clinical trial is designed to show safety and non-inferiority of lung transplant (LTX) with lungs recovered from uDCDDs evaluated by EVLP and ex-vivo CT scan compared to lungs recovered from BDDs. The study began in Sept. 2013, and is scheduled to run until June 30, 2017. Methods: Our organ procurement organization (OPO) began to seek consent for lung recovery for possible LTX from next-of-kin (NOK) of uDCDDs in one urban county. uDCDDs from 4 Emergency Departments (EDs) were added during the first year. Consented recipients at 2 LTX centers in the OPO received whichever lung became available first (uDCDD or BDD), based on blood type, LAS, and size. __ lungs were recovered from uDCDDs. ___ were assessed by EVLP and ex-vivo CT scan. ___ were judged suitable for lung transplant; ___ were transplanted. Outcomes were compared to __ transplanted with lungs recovered from BDDs. Endpoints: Primary outcome measures: Primary Graft Dysfunction (PGD) score at 72 hours and 30-day and one-year survival. Secondary outcome measures: PGD score at 24 hours; mechanical ventilation time; on ventilator or ECMO 7 days after LTX; ICU length of stay (LOS); hospital LOS; requirement for re-intubation; incidence of biopsy proven acute rejection; and incidence of bronchial complications. See Table for results. To date, lungs from 2 uDCDDs were judged suitable for transplant, but no uDCDD lungs have yet been transplanted. Data will be updated before March 23. 1( 039) Successfully Weaned Patients after VA ECMO Due to Cardiogenic Shock: Etiology and 1-Year Survival D. Pabst ,1 A. Ghodsizad,1 A. El-Banayosy,2 B. Soleimani,1 C. Brehm.1 1Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA; 2INTEGRIS Baptist Medical Center, Oklahoma City, OK. Purpose: Congestive heart failure is one of the leading causes of hospital admission in adult patients with heart disease. Patients with decompensated cardiac failure clinically present with cardiogenic shock in which a venoarterial extracorporeal membrane oxygenation (VA-ECMO) is often the final treatment option. Methods: In our institution a cohort of 155 patients received VA ECMO for cardiogenic shock between June 2008 and October 2014. 1-year survival, etiology and post-weaning process of these patients were investigated. Results: Out of 155 patients, 83 (53.6%) were able to be weaned from ECMO and were discharged. 66 (79.6%) of the 83 patients survived the first year after ECMO-treatment. 43 (51.8%) of the patients developed cardiogenic shock due to an acute myocardial infarction (aMI) or acute decompensated ischemic cardiomyopathy, of which, 9 underwent coronary artery bypass grafting (CABG) procedure prior to ECMO placement. An additional 25 (30.1%) patients underwent cardiac surgery for other reasons (7 (8.4%) valve surgery, 6 (7.2%) both valve and CABG surgeries, 4 (4.8%) elective CABG surgery, 6 (7.2%) heart transplantation, 1 (1.2%) PFO surgery and 1 (1.2%) myectomy) directly prior to or while showing signs of cardiogenic shock. 8 patients (9.6%) had a non-ischemic cardiomyopathy, 3 patients (3.6%) had a graft failure after heart transplantation and 3 (3.6%) of the patients suffered from pulmonary emboli. Furthermore 1 (1.2%) of the patients had a cardiogenic shock due to a pericardial effusion after stenting a stenosis of the superior vena cava.
1( 040) Left Ventricular Assist Device Placement with Concomitant Ventricular Reconstruction for Aneurysmal Disease J.W. Smith , J.D. Pal, D. Walters, C.M. Mahr, N.A. Mokadam. Univ of Washington, Seattle, WA. Purpose: Left ventricular aneurysms a surgical challenge in patients with advanced heart failure requiring implantation of a left ventricular assist device. We describe our institutional experience with left ventricular reconstruction at the time of LVAD implantation. Methods: The medical records of all patients who underwent LVAD implantation between January 1, 2007 and December 31, 2014 were reviewed and patients with left ventricular aneurysms were identified. Individual records were reviewed to determine perioperative and long-term outcomes. Results: During the study period, five patients were identified with left ventricular aneurysms. One patient had previously undergone a lateral wall linear resection. All five patients had technically successful LVAD implantation, four with concomitant left ventricular reconstruction. Two patients underwent ventriculoplasty with usual apical inflow cannulation. Two patients had anterior Dor procedures with incorporation of the inflow cannula site into the repair. In order to prevent thrombotic complications, aneurysms were resected and all adherent thrombus removed from the left ventricle. Bovine pericardium was used to cover the left ventricular aspect of resected muscle or septum to reduce the likelihood of thrombus formation. One patient suffered a perioperative stroke with poor neurologic recovery, and the family elected to withdraw support. Four of the five patients survived to discharge. Two patients remain on mechanical circulatory support as destination therapy, and two of the patients successfully underwent heart transplantation. Conclusion: Left ventricular aneurysm resection and reconstruction during LVAD implantation is technically feasible and may be necessary for appropriate inflow cannula position. The operative approach to left ventricular aneurysms needs to individualized for each patient’s particular anatomy, and the LVAD apical cannulation site is determined by the type of repair required.
1( 041) Left Ventricle Mechanical Circulatory Support Implantation as Successful Bridge to Transplantation for Patients with Cardiac Cachexia M. Hegarova ,1 I. Malek,1 V. Melenovsky,1 Z. Dorazilova,1 J. Kettner,1 J. Maly,2 I. Netuka,2 J. Pirk.2 1Department of Cardiology, IKEM, Prague,