PMID- 36724180 OWN - NLM STAT- MEDLINE DCOM- 20230310 LR - 20230707 IS - 2213-1787 (Electronic) IS - 2213-1779 (Linking) VI - 11 IP - 3 DP - 2023 Mar TI - Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy. PG - 321-330 LID - S2213-1779(22)00657-6 [pii] LID - 10.1016/j.jchf.2022.11.005 [doi] AB - BACKGROUND: It is currently unclear if active left ventricular (LV) unloading should be used as a primary treatment strategy or as a bailout in patients with cardiogenic shock (CS) treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). OBJECTIVES: This study sought to evaluate the association between timing of active LV unloading and implantation of VA-ECMO with outcomes of patients with CS. METHODS: Data from 421 patients with CS treated with VA-ECMO and active LV unloading at 18 tertiary care centers in 4 countries were analyzed. Patients were stratified by timing of device implantation in early vs delayed active LV unloading (defined by implantation before up to 2 hours after VA-ECMO). Adjusted Cox and logistic regression models were fitted to evaluate the association between early active LV unloading and 30-day mortality as well as successful weaning from ventilation. RESULTS: Overall, 310 (73.6%) patients with CS were treated with early active LV unloading. Early active LV unloading was associated with a lower 30-day mortality risk (HR: 0.64; 95% CI: 0.46-0.88) and a higher likelihood of successful weaning from ventilation (OR: 2.17; 95% CI: 1.19-3.93) but not with more complications. Importantly, the relative mortality risk increased and the likelihood of successful weaning from ventilation decreased almost proportionally with the time interval between VA-ECMO implantation and (delayed) initiation of active LV unloading. CONCLUSIONS: This exploratory study lends support to the use of early active LV unloading in CS patients on VA-ECMO, although the findings need to be validated in a randomized controlled trial. CI - Copyright (c) 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Schrage, Benedikt AU - Schrage B AD - Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Lubeck/Kiel, Hamburg, Germany. Electronic address: b.schrage@uke.de. FAU - Sundermeyer, Jonas AU - Sundermeyer J AD - Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Lubeck/Kiel, Hamburg, Germany. FAU - Blankenberg, Stefan AU - Blankenberg S AD - Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Lubeck/Kiel, Hamburg, Germany. FAU - Colson, Pascal AU - Colson P AD - Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire Montpellier, University Montpellier, Montpellier, France. FAU - Eckner, Dennis AU - Eckner D AD - Department of Cardiology, Paracelsus Medical University Nurnberg, Nurnberg, Germany. FAU - Eden, Matthias AU - Eden M AD - Department of Internal Medicine III, Universitatsklinikum Heidelberg, Heidelberg, Germany. FAU - Eitel, Ingo AU - Eitel I AD - German Center for Cardiovascular Research, Partner Site Hamburg/Lubeck/Kiel, Hamburg, Germany; University Heart Center Lubeck, University Hospital Schleswig-Holstein, Lubeck, Germany. FAU - Frank, Derk AU - Frank D AD - German Center for Cardiovascular Research, Partner Site Hamburg/Lubeck/Kiel, Hamburg, Germany; Department of Internal Medicine III-Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany. FAU - Frey, Norbert AU - Frey N AD - Department of Internal Medicine III, Universitatsklinikum Heidelberg, Heidelberg, Germany. FAU - Graf, Tobias AU - Graf T AD - German Center for Cardiovascular Research, Partner Site Hamburg/Lubeck/Kiel, Hamburg, Germany; University Heart Center Lubeck, University Hospital Schleswig-Holstein, Lubeck, Germany. FAU - Kirchhof, Paulus AU - Kirchhof P AD - Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Lubeck/Kiel, Hamburg, Germany; Institute of Cardiovascular Sciences, University of Birmingham and University Hospitals Birmingham and Sandwell and West Birmingham NHS Trusts, Birmingham, United Kingdom. FAU - Kupka, Danny AU - Kupka D AD - Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland. FAU - Landmesser, Ulf AU - Landmesser U AD - Department of Cardiology, Campus Benjamin Franklin, Charite Universitatsmedizin Berlin, Berlin, Germany & German Center for Cardiovascular Research, Partner Site Berlin, Berlin, German. FAU - Linke, Axel AU - Linke A AD - Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universitat Dresden, Dresden, Germany. FAU - Majunke, Nicolas AU - Majunke N AD - Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany. FAU - Mangner, Norman AU - Mangner N AD - Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universitat Dresden, Dresden, Germany. FAU - Maniuc, Octavian AU - Maniuc O AD - Department of Internal Medicine I, University Hospital Wurzburg, Wurzburg, Germany. FAU - Mierke, Johannes AU - Mierke J AD - Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universitat Dresden, Dresden, Germany. FAU - Mobius-Winkler, Sven AU - Mobius-Winkler S AD - Department of Internal Medicine I, University Hospital Jena, Jena, Germany. FAU - Morrow, David A AU - Morrow DA AD - Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. FAU - Mourad, Marc AU - Mourad M AD - Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire Montpellier, University Montpellier, Montpellier, France. FAU - Nordbeck, Peter AU - Nordbeck P AD - Department of Internal Medicine I, University Hospital Wurzburg, Wurzburg, Germany. FAU - Orban, Martin AU - Orban M AD - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. FAU - Pappalardo, Federico AU - Pappalardo F AD - Advanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy; Department of Cardiothoracic Anesthesia and Intensive Care, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. FAU - Patel, Sandeep M AU - Patel SM AD - Department of Interventional Cardiology, St. Rita's Medical Center, Lima, Ohio, USA. FAU - Pauschinger, Matthias AU - Pauschinger M AD - Department of Cardiology, Paracelsus Medical University Nurnberg, Nurnberg, Germany. FAU - Pazzanese, Vittorio AU - Pazzanese V AD - Advanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy; Intensive Cardiac Care Unit, San Raffaele Hospital, Milan, Italy. FAU - Radakovic, Darko AU - Radakovic D AD - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University of Bochum, Bad Oeynhausen, Germany. FAU - Schulze, P Christian AU - Schulze PC AD - Department of Internal Medicine I, University Hospital Jena, Jena, Germany. FAU - Scherer, Clemens AU - Scherer C AD - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. FAU - Schwinger, Robert H G AU - Schwinger RHG AD - Medizinische Klinik II, Klinikum Weiden, Weiden, Germany. FAU - Skurk, Carsten AU - Skurk C AD - Department of Cardiology, Campus Benjamin Franklin, Charite Universitatsmedizin Berlin, Berlin, Germany & German Center for Cardiovascular Research, Partner Site Berlin, Berlin, German. FAU - Thiele, Holger AU - Thiele H AD - Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany. FAU - Varshney, Anubodh AU - Varshney A AD - Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. FAU - Wechsler, Lukas AU - Wechsler L AD - Medizinische Klinik II, Klinikum Weiden, Weiden, Germany. FAU - Westermann, Dirk AU - Westermann D AD - Department of Cardiology and Angiology, University Heart Center, University Freiburg, Freiburg, Germany. Electronic address: dirk.westermann@uniklinik-freiburg.de. LA - eng SI - ClinicalTrials.gov/NCT05577195 PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230111 PL - United States TA - JACC Heart Fail JT - JACC. Heart failure JID - 101598241 SB - IM CIN - JACC Heart Fail. 2023 Mar;11(3):331-333. PMID: 36881391 CIN - JACC Heart Fail. 2023 Jul;11(7):862. PMID: 37407160 CIN - JACC Heart Fail. 2023 Jul;11(7):863. PMID: 37407161 MH - Humans MH - *Heart Failure/therapy MH - *Extracorporeal Membrane Oxygenation MH - Shock, Cardiogenic MH - Hospital Mortality MH - Heart Ventricles OTO - NOTNLM OT - cardiogenic shock OT - extracorporeal membrane oxygenation OT - left ventricular unloading COIS- Funding Support and Author Disclosures Drs Schrage and Westermann were funded by the German Center for Cardiovascular Research, and Dr Schrage is also funded by the Else Kroner-Fresenius-Stiftung. This study was funded by an unrestricted research grant from Abiomed. However, Abiomed was not involved in the design of the study, the collection and analysis of the data, the writing of the manuscript, or the decision to publish. Dr Schrage has received speaker fees from Abiomed and AstraZeneca, outside of the submitted work. Dr Blankenberg has received grants and personal fees from Abbott Diagnostics, Bayer, Siemens, and Thermo Fisher; grants from Singulex; and personal fees from Abbott, AstraZeneca, AMGEN, Medtronic, Pfizer, Roche, Siemens Diagnostics, and Novartis, outside of the submitted work. Dr Eckner has received speaker fees from Abiomed, Bayer, and Daiichi Sankyo, outside of the submitted work. Dr Kirchhof has received research support for basic, translational, and clinical research projects from the European Union, British Heart Foundation, Leducq Foundation, Medical Research Council (United Kingdom), and German Center for Cardiovascular Research; has received research support from several drug and device companies active in atrial fibrillation; has received honoraria from several such companies in the past but not in the last 3 years; and is listed as inventor on 2 patents held by the University of Birmingham (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783; unrelated to the submitted work). Dr Mangner has received personal fees from Edwards Lifesciences, Medtronic, Biotronik, Novartis, Sanofi Genzyme, AstraZeneca, Pfizer, Bayer, Abbott, Abiomed, and Boston Scientific, outside the submitted work. Dr Mierke has received speaker fees from Abiomed, outside the submitted work. Dr Morrow has served as a member of the TIMI Study Group, which has received institutional research grant support through Brigham and Women's Hospital from Abbott Laboratories, Amgen, Anthos Therapeutics, Arca Biopharma, AstraZeneca, Bayer HealthCare Pharmaceuticals, Daiichi Sankyo, Eisai, Intarcia, Janssen, Merck, Novartis, Pfizer, Quark Pharmaceuticals, Regeneron, Roche, Siemens, The Medicines Company, and Zora Biosciences; and received consulting fees from Arca Biopharma, Bayer Pharma, InCarda, Inflammatix, Merck, Novartis, and Roche Diagnostics. Dr Pappalardo has served as a consultant for Abiomed. Dr Westermann has received speaker fees from Abiomed, AstraZeneca, Bayer, Berlin-Chemie, Boehringer Ingelheim, Novartis, and Medtronic, outside of the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. EDAT- 2023/02/02 06:00 MHDA- 2023/03/11 06:00 CRDT- 2023/02/01 13:34 PHST- 2022/05/20 00:00 [received] PHST- 2022/10/25 00:00 [revised] PHST- 2022/11/03 00:00 [accepted] PHST- 2023/02/02 06:00 [pubmed] PHST- 2023/03/11 06:00 [medline] PHST- 2023/02/01 13:34 [entrez] AID - S2213-1779(22)00657-6 [pii] AID - 10.1016/j.jchf.2022.11.005 [doi] PST - ppublish SO - JACC Heart Fail. 2023 Mar;11(3):321-330. doi: 10.1016/j.jchf.2022.11.005. Epub 2023 Jan 11.