PMID- 30497643
OWN - NLM
STAT- MEDLINE
DCOM- 20200109
LR  - 20200109
IS  - 2213-1787 (Electronic)
IS  - 2213-1779 (Linking)
VI  - 6
IP  - 12
DP  - 2018 Dec
TI  - Unloading of the Left Ventricle During Venoarterial Extracorporeal Membrane 
      Oxygenation Therapy in Cardiogenic Shock.
PG  - 1035-1043
LID - S2213-1779(18)30713-3 [pii]
LID - 10.1016/j.jchf.2018.09.009 [doi]
AB  - OBJECTIVES: This report relates the authors' ongoing experience with percutaneous 
      left ventricular (LV) unloading by using a transaortic LV assist device in 
      combination with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and 
      provides an in-depth analysis of the hemodynamic benefit of this approach. 
      BACKGROUND: VA-ECMO is increasingly used in cases of severe cardiogenic shock. 
      However, increase in afterload with subsequent LV overload is a major drawback of 
      VA-ECMO. METHODS: Consecutive patients were treated with a transaortic LV assist 
      device in addition to VA-ECMO for cardiogenic shock. The primary endpoint was 
      30-day all-cause mortality. Additional endpoints included weaning from VA-ECMO 
      and safety endpoints. RESULTS: Between September 2013 and January 2018, 106 
      patients were treated with percutaneous LV unloading, using a transaortic LV 
      assist device in combination with VA-ECMO. Successful weaning from VA-ECMO 
      support was achieved in 51.9% of all patients. In the overall cohort, survival at 
      day 30 was 35.8%, which was higher than predicted by the SAVE score (20%) or by 
      the SAPS-II score (6.9%). Right heart catheterization indicated a marked decrease 
      of PCWP after addition of the device to VA-ECMO. CONCLUSIONS: The strategy of 
      percutaneous LV unloading using a transaortic LV assist device in combination 
      with VA-ECMO improved outcome in an all-comers cohort compared to established 
      risk scores. A prospective, randomized study is needed to further investigate 
      this approach.
CI  - Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Schrage, Benedikt
AU  - Schrage B
AD  - Department of General and Interventional Cardiology, University Heart Center 
      Hamburg Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research, 
      Partner site Hamburg/Kiel/Lubeck, Hamburg, Germany.
FAU - Burkhoff, Daniel
AU  - Burkhoff D
AD  - Cardiovascular Research Foundation, New York, New York.
FAU - Rubsamen, Nicole
AU  - Rubsamen N
AD  - Department of General and Interventional Cardiology, University Heart Center 
      Hamburg Eppendorf, Hamburg, Germany.
FAU - Becher, Peter Moritz
AU  - Becher PM
AD  - Department of General and Interventional Cardiology, University Heart Center 
      Hamburg Eppendorf, Hamburg, Germany.
FAU - Schwarzl, Michael
AU  - Schwarzl M
AD  - Department of General and Interventional Cardiology, University Heart Center 
      Hamburg Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research, 
      Partner site Hamburg/Kiel/Lubeck, Hamburg, Germany.
FAU - Bernhardt, Alexander
AU  - Bernhardt A
AD  - Department of Cardiovascular Surgery, University Heart Center Hamburg Eppendorf, 
      Hamburg, Germany.
FAU - Grahn, Hanno
AU  - Grahn H
AD  - Department of General and Interventional Cardiology, University Heart Center 
      Hamburg Eppendorf, Hamburg, Germany.
FAU - Lubos, Edith
AU  - Lubos E
AD  - Department of General and Interventional Cardiology, University Heart Center 
      Hamburg Eppendorf, Hamburg, Germany.
FAU - Soffker, Gerold
AU  - Soffker G
AD  - Department of Intensive Care Medicine, University Clinic Hamburg Eppendorf, 
      Hamburg, Germany.
FAU - Clemmensen, Peter
AU  - Clemmensen P
AD  - Department of General and Interventional Cardiology, University Heart Center 
      Hamburg Eppendorf, Hamburg, Germany.
FAU - Reichenspurner, Hermann
AU  - Reichenspurner H
AD  - Department of Cardiovascular Surgery, University Heart Center Hamburg Eppendorf, 
      Hamburg, Germany.
FAU - Blankenberg, Stefan
AU  - Blankenberg S
AD  - Department of General and Interventional Cardiology, University Heart Center 
      Hamburg Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research, 
      Partner site Hamburg/Kiel/Lubeck, Hamburg, Germany.
FAU - Westermann, Dirk
AU  - Westermann D
AD  - Department of General and Interventional Cardiology, University Heart Center 
      Hamburg Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research, 
      Partner site Hamburg/Kiel/Lubeck, Hamburg, Germany. Electronic address: 
      d.westermann@uke.de.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JACC Heart Fail
JT  - JACC. Heart failure
JID - 101598241
SB  - IM
CIN - JACC Heart Fail. 2018 Dec;6(12):1044-1046. PMID: 30497644
CIN - JACC Heart Fail. 2019 Apr;7(4):364-365. PMID: 30922512
CIN - JACC Heart Fail. 2019 Apr;7(4):364. PMID: 30922513
MH  - Aged
MH  - Cardiac Catheterization
MH  - Extracorporeal Membrane Oxygenation/*methods/mortality
MH  - Female
MH  - Heart Ventricles
MH  - *Heart-Assist Devices
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Shock, Cardiogenic/mortality/*therapy
MH  - Treatment Outcome
OTO - NOTNLM
OT  - VA-ECMO
OT  - cardiogenic shock
OT  - left ventricular unloading
EDAT- 2018/12/01 06:00
MHDA- 2020/01/10 06:00
CRDT- 2018/12/01 06:00
PHST- 2018/06/27 00:00 [received]
PHST- 2018/09/10 00:00 [revised]
PHST- 2018/09/19 00:00 [accepted]
PHST- 2018/12/01 06:00 [entrez]
PHST- 2018/12/01 06:00 [pubmed]
PHST- 2020/01/10 06:00 [medline]
AID - S2213-1779(18)30713-3 [pii]
AID - 10.1016/j.jchf.2018.09.009 [doi]
PST - ppublish
SO  - JACC Heart Fail. 2018 Dec;6(12):1035-1043. doi: 10.1016/j.jchf.2018.09.009.