The use of extracorporeal life support in adult patients with primary cardiac failure as a bridge to implantable left ventricular assist device

Background. Extracorporeal life support (ECLS) is an effective technique fo r providing emergent circulatory assistance, and may represent a life-savin g option in patients who might not initially be considered a candidate for other forms of circulatory support (extracorporeal or implantable left vent ricular assist device [LVAD]). In the setting of cardiac arrest, ECLS repre sents the only viable method of initiating circulatory support. However, EC LS has a number of disadvantages that include high complication rates (eg, stroke, bleeding) and a limited duration of potential support, which have p revented its widespread acceptance, particularly in the adult population. W ith the increased successful application of longterm implantable LVADs as a bridge to transplant, the major limitation of ECLS could be overcome by br idging patients to a long-term implantable LVAD ("bridge to bridge"), there by reducing the reluctance to utilize ECLS when indicated. After acquisitio n of the HeartMate LVAD (Thermo Cardiosystems, Inc, Woburn, MA) we investig ated the use of ECLS as a bridge to an implantable LVAD and subsequent tran splantation in selected high-risk patients. Methods and Results. From Oct 1, 1996 to Sept 30, 2000, 33 adult patients p resenting with cardiac arrest or severe hemodynamic instability were placed on ECLS for the bridge to bridge indication. Of the 33 patients, 10 patien ts survived to LVAD implant, 1 was bridged directly to transplant, 5 weaned from ECLS, and 16 died on ECLS. Overall, 12 patients survived to discharge . One-year actuarial survival from the initiation of ECLS was 36%. One-year actuarial survival from the time of LVAD implant, conditional on surviving ECLS, was 80%. Conclusions. The 1-year survival of adult patients placed on ECLS and who s ubsequently survived to an implantable LVAD was favorable. These data suppo rt a strategy of ECLS to implantable LVAD bridge to heart transplant in adu lt patients who are in need of circulatory support and who are not initiall y candidates for other forms of mechanical support. The favorable results o f this strategy support utilization of ECLS even in situations where myocar dial recovery is thought to be unlikely. (C) 2001 by The Society of Thoraci c Surgeons.