INTRODUCTION
Despite continual improvements in durable left ventricular assist device
(dLVAD) survival and morbidity, outcomes for patients in cardiogenic
shock are inferior to those with less severe heart
failure1. No consensus exists on the optimal method
for stabilizing shock patients prior to dLVAD. Temporary mechanical
circulatory support (tMCS), including extracorporeal membrane
oxygenation (ECMO) and intra-aortic balloon pump (IABP), has been
utilized, with highly variable results. A recent study of the INTERMACS
registry, for instance, found worse survival and more early
complications with ECMO bridging2.
Our standard dLVAD technique is a minimally-invasive lateral
thoracotomy/hemisternotomy (LTHS) using the Heartware HVAD (Medtronic,
Minneapolis, MN)3. This technique yielded excellent
perioperative outcomes and survival in the LATERAL trial, albeit in a
highly selected cohort of mostly INTERMACS 3+
patients4. Utilizing this approach, our group has
observed excellent outcomes in high-acuity patients as well. We
hypothesized that patients requiring tMCS prior to LTHS HVAD would have
similar outcomes to those without tMCS. Further, we propose that LTHS
can be used safely for ECMO-bridged INTERMACS 1 patients without
unacceptably high adverse event rates.