033 RISK FACTORS ASSOCIATED WITH ADVERSE OUTCOME ...

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during ECMO (levosimendan 0.056 ± 0.085 µg/kg/min vs 0.010 ± 0.032 µg/kg/ min, P = 0.063; noradrenaline 0.408 ± 0.355 µg/kg/min vs 0.056 ± 0.097 µg/.
Interactive CardioVascular and Thoracic Surgery

Abstracts – 27th EACTS Sunday

Objectives: INTERMACS level 1 patients have the highest early mortality after ventricular assist device (VAD) implantation. This may, at least in part, be explained by the fact that patients in shock with acutely damaged end-organs and high catecholamine support are exposed to a significant surgical trauma. We hypothesize that a bridge-to-bridge concept with veno-arterial extracorporeal membrane oxygenation (ECMO) for emergency short-term circulatory assistance and deferral of VAD implantation to recovery of end-organ function will reduce the overall mortality of INTERMACS level 1 patients. Methods: We reviewed the concept of initial ECMO implantation and deferral

of VAD implantation to end-organ recovery in 22 consecutive patients (mean age 53.5 ± 14.2 years, 72.2% male, 50% ischaemic cardiomyopathy; 100% INTERMACS level 1, 18.2% HeartMate II, 68.2% HeartWare HVAD, 4.5% HeartWare BiVAD, 9.1% DeBakey) receiving a VAD for refractory cardiogenic shock between June 2004 and February 2013. Study endpoints were end-organ recovery during ECMO support and survival. Results: ECMO support significantly improved renal (creatinine 1.86 ± 0.91 mg/ dl vs 1.32 ± 0.52 mg/dl, P = 0.021), hepatic (GOT 1426 ± 2176 u/l vs 277 ± 259 u/l, P = 0.041; GPT 982 ± 1466 u/l vs 357 ± 447 u/l, P = 0.037) and pulmonary function (FiO2 52 ± 18% vs 26 ± 23%, P < 0.001; PEEP 7 ± 3 mbar vs 5 ± 4 mbar, P = 0.015) over a period of 7.7 ± 7.2 d. Catecholamines could be reduced during ECMO (levosimendan 0.056 ± 0.085 µg/kg/min vs 0.010 ± 0.032 µg/kg/ min, P = 0.063; noradrenaline 0.408 ± 0.355 µg/kg/min vs 0.056 ± 0.097 µg/ kg/min, P = 0.001). Thirty-day mortality was 4.5% and in-hospital mortality 9.1%. Conclusions: Preoperative patient optimization using ECMO support improves outcomes of INTERMACS level 1 patients receiving a permanent ventricular assist device.

Abstracts 001–006

030 PREOPERATIVE PATIENT OPTIMIZATION USING EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT IMPROVES OUTCOMES OF INTERMACS LEVEL 1 PATIENTS RECEIVING A PERMANENT VENTRICULAR ASSIST DEVICE J. Riebandt1, S. Mahr1, T. Haberl1, G. Laufer1, A. Rajek2, H. Schima3, D. Zimpfer1 1 Department of Cardiac Surgery, 2Department of Anesthesia, General Intensive Care and Pain Management, 3Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria