Outcomes of venopulmonary arterial extracorporeal life support as temporary right ventricular support after left ventricular assist implantation

Objectives: We report our experience with temporary postoperative venopulmonary arterial extracorporeal life support as short-term right ventricular support in patients with biventricular failure undergoing HeartWare (HeartWare Inc, Framingham, Mass) left ventricular assist device implantation and compared these outcomes with isolated left ventricular assist device support and long-term biventricular assist device support. Methods: A total of 112 consecutive patients were studied, 75 with the isolated HeartWare left ventricular assist device, 23 with a concomitant left ventricular assist device and venopulmonary arterial extracorporeal life support, and 14 with durable biventricular assist device support. The decision concerning short-term or durable biventricular support was based on the clinical characteristics, echocardiography, and hemodynamic profile. Results: Patients who required venopulmonary arterial extracorporeal life support after left ventricular assist device insertion required the greatest support preoperatively and were more likely to have Interagency Registry for Mechanical Assisted Circulatory Support level 1 (left ventricular assist device 19%, venopulmonary arterial extracorporeal life support 48 %, biventricular assist device 57 %, P < .001). They were more likely to require preoperative mechanical support (left ventricular assist device 9%, venopulmonary arterial extracorporeal life support 43%, and biventricular assist device 29%, P < .001) or preoperative ventilation (9%, 38%, and 21%, respectively, P < .05). Preoperative echocardiographic and hemodynamic parameters were more similar to those requiring isolated left ventricular assist device, with patients requiring durable biventricular assist device support more likely to have elevated right atrial pressure (left ventricular assist device 14.3 +/- 6.7 vs venopulmonary arterial extracorporeal life support 13.6 +/- 4.8 vs biventricular assist device 18.7 +/- 6.0 mm Hg, P < .05); right atrial/pulmonary capillary wedge pressure ratio (0.53 +/- 0.23 vs 0.51 +/- 0.17, vs 0.69 +/- 0.22, respectively, P < .02); and tricuspid regurgitation grade (1.7 +/- 1.5 vs 1.7 +/- 1.6 vs 2.8 +/- 1.6, respectively, P < .01). One-year survival was 84% for those with an isolated left ventricular assist device compared with 62% for those with venopulmonary arterial extracorporeal life support and 64.3 % for biventricular assist device. Conclusions: In critically unwell patients requiring temporary biventricular support, planned venopulmonary arterial extracorporeal life support provides acceptable outcomes, similar to durable biventricular assist device support. Requirement for venopulmonary arterial extracorporeal life support is more determined by the level of preoperative acuity than echocardiographic or hemodynamic parameters.