Quality of Life after Urgent LVAD Implantation under ECMO Therapy Due to Cardiogenic Shock: A Long-Term Follow-up

Objectives: In over a decade, a venoarterial extracorporeal membrane oxygenation (VA-ECMO) has used to be an accepted therapy for cardiogenic shock (CS) refractory to maximal conservative treatment. Successful weaning is not always possible and bridging with further mechanical circulatory support (MCS) such as an urgent implantation of a left ventricular assist device (LVAD) remains in particular situations the only alternative to keep the patient alive. After recovery the survivors are faced with new issues concerning living with LVAD, often without preceded preparation. Despite of many publications concerning hospital survival there are only limited data about long term outcome and quality of life of the survivors.

Methods: A retrospective analysis of Institute's database for years 2012 to 2019 was performed to identify the patients treated with VA-ECMO due to CS who underwent urgent implantation of LVAD while on MCS. Postcardiotomy cases were excluded. A QoL was obtained during a routine follow up visit using EQ-5D-5L and PHQ-9 questionnaires.

Result: Among 126 survivals of VA-ECLS therapy due to cardiogenic shock without prior cardiac surgery, there were 30 (23.8%) urgent LVAD recipients identified. In 11 (36.7%) cases, a cardiopulmonary resuscitation (CPR) has to be performed (median: 10, range: 1–60 minutes) before initiation of VA-ECLS and in 5 (16.7%) cases MCS was established under CPR. Mean age at LVAD implantation was 51.8 (±14.2) years and the surgery was performed after mean time of 12.3 (±8) days of VA-ECMO support. During follow-up of 36.3 (±23.7) months, there were five deaths after 17.7 (±11.6) months of LVAD support. Four patients could be successfully weaned from device after mean time of 18.6 (±11.5) months. Four patients were lost to follow-up and one denied to completing the questionnaires. QoL could be obtained in 20 survivals after mean time of 44.4 (±23.3) months after LVAD implantation. Analysis of QoL questionnaires returned a mean EQ-5D-5L score of 67 (±21) % of societal valuation for Germany and a mean PHQ-9 score of 6 (±4.1) corresponding to mild depression severity.

Conclusion: Long-term survival rates in patients requiring urgent LVAD-implantation under VA-ECMO support due to CS are associated with acceptable quality of life. Close follow-up is required to oversee the result after successful initial treatment.

Publication History

Article published online:
19 February 2021