Isolated left ventricular failure is a predictor of poor outcome in patients receiving veno-arterial extracorporeal membrane oxygenation

Abstract

Aims: We investigated survival according to the nature of heart failure (isolated left, vs isolated right, vs biventricular heart failure) in patients undergoing extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock of different causes.

Methods and results: This single-center study included 132 patients with acute myocardial infarction (20%), acute on chronic heart failure (14%), post cardiotomy (17%), cardiac allograft failure (8%), pulmonary embolism (16%), and acute nonischemic heart failure (25%). Ventricular function was a priori assessed by transthoracic echocardiography (isolated left (26%), isolated right (22%), or biventricular heart failure (52%)). The primary endpoint was all-cause mortality at 90 days and long-term. Predictors for adverse outcome were identified by univariate and multivariate Cox regression analysis. Median duration of ECMO support was 6 [3-9] days. Ninety-day survival was 51% (isolated LV failure 32% vs. isolated RV failure 62% vs. biventricular failure 55%, p = 0.04). The presence of isolated left ventricular failure was a predictor for 90-day mortality, irrespective of diagnosis and SAVE score. In patients who survived 90 days following ECMO implantation, long-term (4-year) survival was excellent (95%, no difference between subgroups).

Conclusion: Isolated left ventricular failure was an independent predictor for 90-day outcome.

Keywords: Cardiogenic shock; Echocardiography; Extracorporeal membrane oxygenation; Outcome; Ventricular failure.