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Titolo:
Assessment of an extracorporeal life support to LVAD bridge to heart transplant strategy
Autore:
Pagani, FD; Aaronson, KD; Dyke, DB; Wright, S; Swaniker, F; Bartlett, RH;
Indirizzi:
Univ Michigan, Sect Cardiac Surg, Heart Transplant & Circulatory Assist Program, Div Cardiol, Ann Arbor, MI 48109 USA Univ Michigan Ann Arbor MI USA48109 Div Cardiol, Ann Arbor, MI 48109 USA Univ Michigan, Sect Surg Crit Care, Ann Arbor, MI 48109 USA Univ MichiganAnn Arbor MI USA 48109 g Crit Care, Ann Arbor, MI 48109 USA
Titolo Testata:
ANNALS OF THORACIC SURGERY
fascicolo: 6, volume: 70, anno: 2000,
pagine: 1977 - 1984
SICI:
0003-4975(200012)70:6<1977:AOAELS>2.0.ZU;2-P
Fonte:
ISI
Lingua:
ENG
Soggetto:
VENTRICULAR ASSIST DEVICES; POSTCARDIOTOMY CARDIOGENIC-SHOCK; MEMBRANE-OXYGENATION; ATRIAL SEPTOSTOMY; SURVIVAL; DECOMPRESSION; EXPERIENCE; MORTALITY; ADULTS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
22
Recensione:
Indirizzi per estratti:
Indirizzo: Pagani, FD Univ Michigan, Sect Cardiac Surg, Heart Transplant & Circulatory Assist Program, Div Cardiol, Taubman 2120,Box 0344,1500 E Med Ctr Dr, AnnArbor, MI 48109 USA Univ Michigan Taubman 2120,Box 0344,1500 E Med Ctr Dr Ann Arbor MI USA 48109
Citazione:
F.D. Pagani et al., "Assessment of an extracorporeal life support to LVAD bridge to heart transplant strategy", ANN THORAC, 70(6), 2000, pp. 1977-1984

Abstract

Background. Extracorporeal life support (ECLS) is an effective technique for providing emergent circulatory assistance. However, its use in adult patients is associated with poor survival when myocardial function fails to recover. Due to the prolonged waiting times for heart transplantation, ECLS as a bridge to transplant is associated with poor survival. In addition, ECLS has been reported to be a significant risk factor for death after bridging to an implantable left ventricular assist device (LVAD). After acquisition of the HeartMate LVAD (Thermo Cardiosystems, Inc) in October 1996, we began using ECLS as a bridge to an implantable LVAD and subsequently transplantation in selected high-risk patients. Methods. From October 1, 1996 to December 1, 1999, 60 adult patients presenting with cardiogenic shock were evaluated for circulatory assistance. Results. Twenty-five patients (group 1) with cardiac arrest or severe hemodynamic instability and multiorgan failure were placed on ECLS. Eight patients survived to LVAD implant, 1 was bridged directly to transplant, and 4 weaned from ECLS. Nine patients in group 1 survived to discharge. Thirty patients (group 2) underwent LVAD implant without ECLS. Twenty-three were bridged to transplant, with 22 surviving to discharge. Five patients (group 3) were placed on extracorporeal ventricular assist with 3 bridged to transplant and all surviving to discharge. One-year actuarial survival from the initiation of circulatory support was 36% (group 1), 73% (group 2), and 60% (group 3). One-year actuarial survival from the time of LVAD implant in group1, conditional on surviving ECLS, was 75% (p = NS compared with group 2). Conclusions. In selected high-risk patients, LVAD survival after initial ECLS was not different from survival after LVAD support alone. An initial period of resuscitation with ECLS is an effective strategy to salvage patients with cardiac arrest or extreme hemodynamic instability and multiorgan injury. (Ann Thorac Surg 2000;70:1977-85) (C) 2000 by The Society of Thoracic Surgeons.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 18/01/20 alle ore 07:58:16