INTRODUCTION
Despite continual improvements in durable left ventricular assist device (dLVAD) survival and morbidity, outcomes for patients in cardiogenic shock are inferior to those with less severe heart failure1. No consensus exists on the optimal method for stabilizing shock patients prior to dLVAD. Temporary mechanical circulatory support (tMCS), including extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP), has been utilized, with highly variable results. A recent study of the INTERMACS registry, for instance, found worse survival and more early complications with ECMO bridging2.
Our standard dLVAD technique is a minimally-invasive lateral thoracotomy/hemisternotomy (LTHS) using the Heartware HVAD (Medtronic, Minneapolis, MN)3. This technique yielded excellent perioperative outcomes and survival in the LATERAL trial, albeit in a highly selected cohort of mostly INTERMACS 3+ patients4. Utilizing this approach, our group has observed excellent outcomes in high-acuity patients as well. We hypothesized that patients requiring tMCS prior to LTHS HVAD would have similar outcomes to those without tMCS. Further, we propose that LTHS can be used safely for ECMO-bridged INTERMACS 1 patients without unacceptably high adverse event rates.