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The outcomes of a standardized protocol for extracorporeal mechanical circulatory support selection-left ventricular challenge protocol

  • Original Article
  • Artificial Heart (Clinical)
  • Published:
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Abstract

There are no criteria for surgical mechanical circulatory system (MCS) selection for acute heart failure. Since 2021, we have utilized cardiopulmonary bypass system to assess patients’ heart and lung condition to inform surgical MCS selection. we aimed to retrospectively analyze the outcomes of treatments administered using our protocol. We analyzed the data of 19 patients who underwent surgical MCS implantation. We compared patients’ characteristics across the biventricular-assist device (BiVAD), central Y-Y extracorporeal membrane oxygenation (ECMO), central ECMO, and left VAD (LVAD) systems. Patients' diagnoses included fulminant myocarditis (47.4%), dilated cardiomyopathy (21.1%), acute myocardial infarction (15.8%), infarction from aortic dissection (5.3%), doxorubicin-related cardiomyopathy (5.3%), and tachycardia-induced myocarditis (5.3%). Eight patients (42.1%) underwent LVAD implantation, 1 (5.2%) underwent central ECMO, 4 (21.1%) underwent BiVAD implantation, and 6 (31.6%) underwent central Y-Y ECMO. 48 h after surgery, both the pulmonary arterial and right atrial pressures were effectively controlled, with median values being 19.0 mmHg and 9.0 mmHg, respectively. No patients transitioned from LVAD to BiVAD in the delayed period. Cerebrovascular events occurred in 21.1%. Successful weaning was achieved in 11 patients (57.9%), and 5 patients (26.3%) were converted to durable LVAD. Two-year cumulative survival was 84.2%. Our protocol showed good results for device selection in patients with heart failure, and device selection according to this protocol enabled good control of the pulmonary and systemic circulations.

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The data underlying this article will be shared with the corresponding author at a reasonable request.

References

  1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599–726.

    Article  CAS  PubMed  Google Scholar 

  2. Khorsandi M, Schroder J, Daneshmand M, Bishawi M, Bouamra O, Winterton P, et al. Outcomes after extracorporeal right ventricular assist device combined with durable left ventricular assist device support. Ann Thorac Surg. 2019;107:1768–74.

    Article  PubMed  Google Scholar 

  3. Sun R, Guo Q, Wang J, Zou Y, Chen Z, Wang J, et al. Central venous pressure and acute kidney injury in critically ill patients with multiple comorbidities: a large retrospective cohort study. BMC Nephrol. 2022;23:83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Fitzpatrick JR 3rd, Frederick JR, Hiesinger W, Hsu VM, McCormick RC, Kozin ED, et al. Early planned institution of biventricular mechanical circulatory support results in improved outcomes compared with delayed conversion of a left ventricular assist device to a biventricular assist device. J Thorac Cardiovasc Surg. 2009;137:971–7.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Takeda K, Naka Y, Yang JA, Uriel N, Colombo PC, Jorde UP, et al. Outcome of unplanned right ventricular assist device support for severe right heart failure after implantable left ventricular assist device insertion. J Heart Lung Transplant. 2014;33:141–8.

    Article  PubMed  Google Scholar 

  6. Haanschoten MC, Kreeftenberg HG, Arthur Bouwman R, van Straten AH, Buhre WF, Soliman Hamad MA. Use of postoperative peak arterial lactate level to predict outcome after cardiac surgery. J Cardiothorac Vasc Anesth. 2017;31:45–53.

    Article  PubMed  Google Scholar 

  7. Hajjar LA, Almeida JP, Fukushima JT, Rhodes A, Vincent JL, Osawa EA, et al. High lactate levels are predictors of major complications after cardiac surgery. J Thorac Cardiovasc Surg. 2013;146:455–60.

    Article  CAS  PubMed  Google Scholar 

  8. Fux T, Holm M, Corbascio M, Lund LH, van der Linden J. Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock: risk factors for mortality. J Thorac Cardiovasc Surg. 2018;156:1894-902.e3.

    Article  PubMed  Google Scholar 

  9. Aissaoui N, Morshuis M, Schoenbrodt M, Hakim Meibodi K, Kizner L, Börgermann J, et al. Temporary right ventricular mechanical circulatory support for the management of right ventricular failure in critically ill patients. J Thorac Cardiovasc Surg. 2013;146:186–91.

    Article  PubMed  Google Scholar 

  10. Saito S, Sakaguchi T, Miyagawa S, Nishi H, Yoshikawa Y, Fukushima S, et al. Recovery of right heart function with temporary right ventricular assist using a centrifugal pump in patients with severe biventricular failure. J Heart Lung Transplant. 2012;31:858–64.

    Article  PubMed  Google Scholar 

  11. John R, Long JW, Massey HT, Griffith BP, Sun BC, Tector AJ, et al. Outcomes of a multicenter trial of the Levitronix CentriMag ventricular assist system for short-term circulatory support. J Thorac Cardiovasc Surg. 2011;141:932–9.

    Article  PubMed  Google Scholar 

  12. Farag J, Woldendorp K, McNamara N, Bannon PG, Marasco SF, Loforte A, et al. Contemporary outcomes of continuous-flow biventricular assist devices. Ann Cardiothorac Surg. 2021;10:311–28.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kirklin JK, Naftel DC, Kormos RL, Stevenson LW, Pagani FD, Miller MA, et al. Fifth INTERMACS annual report: risk factor analysis from more than 6,000 mechanical circulatory support patients. J Heart Lung Transplant. 2013;32:141–56.

    Article  PubMed  Google Scholar 

  14. Kirklin JK, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Myers SL, et al. Eighth annual INTERMACS report: special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017;36:1080–6.

    Article  PubMed  Google Scholar 

  15. Raffa GM, Kowalewski M, Brodie D, Ogino M, Whitman G, Meani P, et al. Meta-analysis of peripheral or central extracorporeal membrane oxygenation in postcardiotomy and non-postcardiotomy shock. Ann Thorac Surg. 2019;107:311–21.

    Article  PubMed  Google Scholar 

  16. Ranney DN, Benrashid E, Meza JM, Keenan JE, Bonadonna DK, Bartz R, et al. Central cannulation as a viable alternative to peripheral cannulation in extracorporeal membrane oxygenation. Semin Thorac Cardiovasc Surg. 2017;29:188–95.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Emily Woodhouse, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-7 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan

    Naoki Tadokoro, Kohei Tonai, Satoshi Kainuma, Naonori Kawamoto & Satsuki Fukushima

  2. Department of Clinical Engineering, National Cerebral and Cardiovascular Center, Osaka, Japan

    Tetsuya Koyamoto, Yuki Yoshida, Koudai Hirahsima & Hiroshi Nishioka

  3. Department of Surgical Intensive Care, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan

    Kimito Minami

  4. Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan

    Tsukamoto Yasumasa

  5. Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Tomoyuki Fujita

Authors
  1. Naoki Tadokoro
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  2. Tetsuya Koyamoto
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  3. Kohei Tonai
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  4. Yuki Yoshida
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  7. Naonori Kawamoto
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  10. Tsukamoto Yasumasa
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  11. Tomoyuki Fujita
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  12. Satsuki Fukushima
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Contributions

Conceptualization: NT, TK, YY, KH, HN; Methodology: NT, TK, KT, NK; Formal analysis and investigation: KM, NT, SK, TY; Writing—original draft preparation: NT; Writing—review and editing: Satsuki Fukushima; Supervision: SK, SF, TF.

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Correspondence to Naoki Tadokoro or Satsuki Fukushima.

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Tadokoro, N., Koyamoto, T., Tonai, K. et al. The outcomes of a standardized protocol for extracorporeal mechanical circulatory support selection-left ventricular challenge protocol. J Artif Organs (2024). https://doi.org/10.1007/s10047-023-01427-7

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  • DOI: https://doi.org/10.1007/s10047-023-01427-7

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