Left Ventricular Unloading With Surgically Implanted Microaxial Flow Pump in Patients on Venoarterial Membrane Oxygenation.

IF 3.1 3区医学 Q2 ENGINEERING, BIOMEDICAL ASAIO Journal Pub Date : 2024-12-18 DOI:10.1097/MAT.0000000000002364

Pia Lanmüller, Nils Hinrichs, Gaik Nersesian, Daniel Lewin, Ben O'Brien, Volkmar Falk, Evgenij Potapov, Christoph Starck, Sascha Ott

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Abstract

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is applied for the treatment of cardiogenic shock. Concomitant left ventricular unloading (LVU) with a microaxial flow pump (mAFP) enables myocardial and pulmonary recovery and may overcome some of the limitations of VA-ECMO. The study included 145 cardiogenic shock patients, 89 (61.4%) of whom were treated with VA-ECMO alone (ECMO group), whereas 56 (38.6%) received LVU with a surgically implanted mAFP on top of VA-ECMO (ECMELLA group). After 2:1 propensity score matching, 30 day and 1 year survival was similar between the groups ( p = 0.62 and 0.68, respectively). In the subgroup analysis, patients who received mAFP in the first 2 hours after VA-ECMO implantation had an improved 30 day (hazard ratio [HR]: 0.45 [95% confidence interval {CI}: 0.23-0.88], p = 0.02) and 1 year survival (HR: 0.52 [95% CI: 0.28-0.97], p = 0.04). The rate of limb ischemia, hemorrhage, and renal replacement therapy were comparable between the propensity score-matched cohorts. Early LVU with a surgically implanted mAFP in patients on VA-ECMO improved short-and long-term survival.

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手术植入微轴流泵对静脉动脉膜氧合患者左心室负荷的影响。

静脉体外膜氧合（VA-ECMO）用于治疗心源性休克。伴随左心室卸载（LVU）与微轴流泵（mAFP）可以使心肌和肺恢复，并可能克服VA-ECMO的一些局限性。本研究纳入145例心源性休克患者，其中89例（61.4%）患者单独接受VA-ECMO治疗（ECMO组），56例（38.6%）患者在VA-ECMO的基础上接受LVU +手术植入mAFP （ECMELLA组）。经2:1倾向评分匹配后，两组间30天和1年生存率相似（p分别= 0.62和0.68）。在亚组分析中，VA-ECMO植入后2小时内接受mAFP治疗的患者30天生存率提高（风险比[HR]: 0.45[95%可信区间{CI}: 0.23-0.88], p = 0.02）， 1年生存率提高（HR: 0.52 [95% CI: 0.28-0.97], p = 0.04）。在倾向评分匹配的队列中，肢体缺血、出血和肾脏替代治疗的发生率是相当的。早期LVU手术植入mAFP的VA-ECMO患者可提高短期和长期生存率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ASAIO Journal 医学-工程：生物医学

CiteScore

6.60

自引率

7.10%

发文量

651

审稿时长

4-8 weeks

期刊介绍： ASAIO Journal is in the forefront of artificial organ research and development. On the cutting edge of innovative technology, it features peer-reviewed articles of the highest quality that describe research, development, the most recent advances in the design of artificial organ devices and findings from initial testing. Bimonthly, the ASAIO Journal features state-of-the-art investigations, laboratory and clinical trials, and discussions and opinions from experts around the world. The official publication of the American Society for Artificial Internal Organs.