Bridge from Central Extracorporeal Life Support to Durable LVAD in Acute Heart Failure Elevates a Risk of Stroke Long-Term.

Central extracorporeal life support (ECLS) has been shown to yield a sufficient flow support with unloading of heart and lung in cases having acute refractory heart failure with durable LVAD candidacy being uncertain. In contrast, subsequent implantation of durable LVAD after the bridge by the central ECLS is reportedly associated with morbidities in-hospital and long-term. This study aimed to review outcomes of this bridge strategy from central ECLS to durable LVAD, as compared to those of primary LVAD implantation. This study enrolled an institutional consecutive series of 158 cases who underwent durable LVAD implantation from April 2013 to September 2020. Of these, 43 cases (27%), who were bridged from central ECLS, were compared with 115 cases (73%) who underwent primary durable LVAD implantation. The mean age was 45.2±12.2 years and 111 cases were male. Durable LVAD included HeartMateII 120 cases, HeartMate3 in 38 cases. Before the durable LVAD implantation, there were significant intergroup differences in systolic diameter of the LV (Bridge; 51.7±2.0 vs Primary; 65.0±1.2 mm, p<0.0001), pulmonary capillary wedge pressure (11.1±1.6 vs 20.5±0.9 mmHg, p<0.0001), serum albumin (3.2±0.08 vs 3.9±0.04 g/dL, p<0.0001), and serum creatine level (0.8±0.05 vs 1.0±0.03 g/dL, p<0.0001). As for the intraoperative factors, longer operative time and a larger amount of blood products were required in the bridge group. The overall survival rates were not significantly different (p=0.11), though the rates of stroke incidence were significantly higher in the bridge group (1-year: 30% vs 8%, 5-year: 30% vs 12%, p=0.0025). Cox multivariate hazard analysis in the entire cohort showed that the bridge strategy was an independent risk factor of stroke (hazard ratio, 3.37; P=0.0012; 95% confidence interval, 1.3 - 8.7). In subgroup analysis, cases having stroke showed a smaller preoperative systolic diameter of the LV (55.5±3.1 vs 62.3±1.3 mm, P=0.044) and a larger amount of platelet product use (42.3±3.6 vs 32.7±1.5 units, P=0.017) as compared to those not having stroke. The bridge strategy yielded similar midterm outcomes as compared to the primary strategy, apart from stroke incidence which was more prominent after the bridge strategy. Perioperative care for bleeding potentials may protect from stroke after the bridge strategy. [ABSTRACT FROM AUTHOR]