Background: Implantation of durable LVAD in INTERMACS category 1 patients present unique challenges because of the acuity that precludes social and clinical assessment for durable LVAD therapy. Effective and reliable strategies to optimize INTERMACS 1 patients is in much need. A novel awake venous-arterial extracorporeal membrane oxygenation (aVA ECMO) allows for clinical assessments while temporarily supporting biventricular function and stabilizing end-organ functions. The aim of the study was to assess outcomes of patients with aVA ECMO support prior to durable LVAD implantation.
Methods: We evaluated patients who received durable LVAD in 2012-2015. The cohort comprised of patients who did or did not receive aVA ECMO support prior to durable LVAD. The standard INTERMACS adverse event definitions were used. Kaplan-Meier analysis and Cox proportional hazards analysis were conducted to assess post-LVAD survival and risk of death.
Results: 83 patients received a durable LVAD, of which 19 received aVA ECMO support prior to durable LVAD. 41% of the entire cohort was INTERMACS category 1, with all 19 patients who received aVA ECMO support being in INTERMACS 1 category. No complications were observed during the mean aVA ECMO support of 2.7 days. The overall 12-month survival was 80%. The survival of aVA ECMO-supported patients were superior to that of non-aVA ECMO INTERMACS 1 patients (100% vs. 66.7% at 1 month p=0.007, 84.2% vs. 66.7% at 3 month and 1 year p=0.15) and comparable to that of non-aVA ECMO INTERMACS 2 cohort (84.2% vs. 80.8%) at 1 year. Multivariate analysis demonstrated a significant reduction in the risk of death in aVA ECMO group compared to INTERMACS 1 non-aVA ECMO group (HR 0.174, p=0.035).
Conclusions: Awake VA ECMO allows bridge to next therapy and improves outcomes in INTERMACS category 1 patients with an effect comparable to downgrading the disease severity on the INTERMACS scale.