PMID- 34999807 OWN - NLM STAT- MEDLINE DCOM- 20220307 LR - 20231019 IS - 1569-9285 (Electronic) IS - 1569-9293 (Print) IS - 1569-9285 (Linking) VI - 34 IP - 1 DP - 2022 Jan 6 TI - Left ventricular unloading during extracorporeal life support for myocardial infarction with cardiogenic shock: surgical venting versus Impella device. PG - 137-144 LID - 10.1093/icvts/ivab230 [doi] AB - OBJECTIVES: Patients in cardiogenic shock supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) may experience severe complications from reduced left ventricular (LV) unloading and increased cardiac afterload. These effects are usually modified by adding a percutaneous direct Impella vent or surgical LV vent on top of VA-ECMO in selected patients. However, direct comparisons between 2 LV unloading strategies in patients with cardiogenic shock due to myocardial infarction are lacking. Therefore, we sought to investigate the impact of these 2 different approaches. METHODS: We enrolled 112 patients treated with an Impella or surgical LV vent during VA-ECMO support between January 2014 and February 2020. The primary endpoint was 30-day mortality. Secondary endpoints included rates of myocardial recovery or transition to durable mechanical circulatory support. Additionally, we assessed adverse events such as peripheral ischaemic complications requiring intervention, sepsis and ischaemic stroke. RESULTS: At 30 days, 38 patients in the Impella group (54%) and 26 patients in the surgical LV vent group (63%) had died (relative risk with Impella 0.78, 95% confidence interval 0.47-1.30; P = 0.35). Impella group and the surgical LV vent group differed significantly with respect to the secondary end points including rates of myocardial recovery (24% and 7%, respectively; P = 0.022) and rates of durable mechanical circulatory support (17% and 42%, P = 0.012). Complication rates were not statistically different between the 2 groups. CONCLUSIONS: The use of Impella device as therapeutic unloading therapy during VA-ECMO did not significantly reduce 30-day mortality compared to surgical LV vent in patients with cardiogenic shock due to acute myocardial infarction. CI - (c) The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. FAU - Radakovic, Darko AU - Radakovic D AUID- ORCID: 0000-0002-3380-0747 AD - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. FAU - Zittermann, Armin AU - Zittermann A AUID- ORCID: 0000-0001-6085-6554 AD - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. FAU - Knezevic, Alen AU - Knezevic A AD - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. FAU - Razumov, Artyom AU - Razumov A AD - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. FAU - Opacic, Dragan AU - Opacic D AD - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. FAU - Wienrautner, Nicole AU - Wienrautner N AD - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. FAU - Flottmann, Christian AU - Flottmann C AD - Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. FAU - Rojas, Sebastian V AU - Rojas SV AD - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. FAU - Fox, Henrik AU - Fox H AUID- ORCID: 0000-0002-2187-8715 AD - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. FAU - Schramm, Rene AU - Schramm R AUID- ORCID: 0000-0001-5803-3575 AD - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. FAU - Morshuis, Michiel AU - Morshuis M AUID- ORCID: 0000-0002-6178-5791 AD - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. FAU - Rudolph, Volker AU - Rudolph V AUID- ORCID: 0000-0001-5385-6839 AD - Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. FAU - Gummert, Jan AU - Gummert J AUID- ORCID: 0000-0002-6956-9110 AD - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. FAU - Deutsch, Marcus-Andre AU - Deutsch MA AUID- ORCID: 0000-0002-5928-8737 AD - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany. LA - eng PT - Journal Article DEP - 20210815 PL - England TA - Interact Cardiovasc Thorac Surg JT - Interactive cardiovascular and thoracic surgery JID - 101158399 SB - IM MH - Brain Ischemia/etiology MH - *Extracorporeal Membrane Oxygenation/adverse effects/methods MH - *Heart-Assist Devices/adverse effects MH - Humans MH - *Myocardial Infarction/complications/therapy MH - *Shock, Cardiogenic/diagnosis/etiology/therapy MH - Stroke/etiology PMC - PMC8923515 OTO - NOTNLM OT - Cardiogenic shock OT - Left ventricular unloading OT - Venoarterial extracorporeal membrane oxygenation EDAT- 2022/01/10 06:00 MHDA- 2022/03/08 06:00 PMCR- 2021/08/15 CRDT- 2022/01/09 21:11 PHST- 2021/03/31 00:00 [received] PHST- 2021/05/26 00:00 [revised] PHST- 2021/07/26 00:00 [accepted] PHST- 2022/01/09 21:11 [entrez] PHST- 2022/01/10 06:00 [pubmed] PHST- 2022/03/08 06:00 [medline] PHST- 2021/08/15 00:00 [pmc-release] AID - 6499438 [pii] AID - ivab230 [pii] AID - 10.1093/icvts/ivab230 [doi] PST - ppublish SO - Interact Cardiovasc Thorac Surg. 2022 Jan 6;34(1):137-144. doi: 10.1093/icvts/ivab230. Epub 2021 Aug 15.