Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Artif Organs. 2024 Aug;48(8):921-931. doi: 10.1111/aor.14740. Epub 2024 Mar 8.
The efficacy of extracorporeal membrane oxygenation (ECMO) as a bridge to left ventricular assist device (LVAD) remains unclear, and recipients of the more contemporary HeartMate 3 (HM3) LVAD are not well represented in previous studies. We therefore undertook a multicenter, retrospective study of this population.
INTERMACS 1 LVAD recipients from five U.S. centers were included. In-hospital and one-year outcomes were recorded. The primary outcome was the overall mortality hazard comparing ECMO versus non-ECMO patients by propensity-weighted survival analysis. Secondary outcomes included survival by LVAD type, as well as postoperative and one-year outcomes. One hundred and twenty-seven patients were included; 24 received ECMO as a bridge to LVAD. Mortality was higher in patients bridged with ECMO in the primary analysis (HR 3.22 [95%CI 1.06-9.77], p = 0.039). Right ventricular assist device was more common in the ECMO group (ECMO: 54.2% vs non-ECMO: 11.7%, p < 0.001). Ischemic stroke was higher at one year in the ECMO group (ECMO: 25.0% vs non-ECMO: 4.9%, p = 0.006). Among the study cohort, one-year mortality was lower in HM3 than in HeartMate II (HMII) or HeartWare HVAD (10.5% vs 46.9% vs 31.6%, respectively; p < 0.001) recipients. Pump thrombosis at one year was lower in HM3 than in HMII or HVAD (1.8% vs 16.1% vs 16.2%, respectively; p = 0.026) recipients.
Higher mortality was observed with ECMO as a bridge to LVAD, likely due to higher acuity illness, yet acceptable one-year survival was seen compared with historical rates. The receipt of the HM3 was associated with improved survival compared with older generation devices.
体外膜肺氧合（ECMO）作为左心室辅助装置（LVAD）桥接的疗效尚不清楚，并且在之前的研究中，接受较新的 HeartMate 3（HM3）LVAD 的患者并未得到很好的体现。因此，我们进行了这项多中心、回顾性研究。
纳入了来自美国 5 个中心的 INTERMACS 1 期 LVAD 患者。记录了院内和一年的结局。主要结局是通过倾向评分生存分析比较 ECMO 与非 ECMO 患者的整体死亡率风险。次要结局包括按 LVAD 类型的生存率，以及术后和一年的结局。共纳入 127 例患者，其中 24 例接受 ECMO 作为 LVAD 的桥接。在主要分析中，接受 ECMO 桥接的患者死亡率更高（HR 3.22 [95%CI 1.06-9.77]，p=0.039）。ECMO 组中右心室辅助装置更为常见（ECMO：54.2% vs 非 ECMO：11.7%，p<0.001）。在 ECMO 组中，一年时的缺血性中风发生率更高（ECMO：25.0% vs 非 ECMO：4.9%，p=0.006）。在研究队列中，与 HeartMate II（HMII）或 HeartWare HVAD（分别为 10.5%、46.9%和 31.6%；p<0.001）相比，HM3 的一年死亡率较低。与 HMII 或 HVAD 相比，HM3 组的一年泵血栓发生率较低（分别为 1.8%、16.1%和 16.2%；p=0.026）。
ECMO 作为 LVAD 的桥接死亡率更高，可能是由于疾病更严重，但与历史数据相比，一年生存率可接受。与旧一代设备相比，接受 HM3 与生存率提高有关。
