Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-Up
<i>Background and Objectives</i>: Over the past decade, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has developed into a mainstream treatment for refractory cardiogenic shock (CS) to maximal conservative management. Successful weaning of VA-ECMO may not be possible, and b...
Main Authors: | , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
MDPI AG
2021-07-01
|
Series: | Medicina |
Subjects: | |
Online Access: | https://www.mdpi.com/1648-9144/57/8/747 |
id |
doaj-e615d18cc7364b5ab0af9897cde186ea |
---|---|
record_format |
Article |
spelling |
doaj-e615d18cc7364b5ab0af9897cde186ea2021-08-26T14:02:42ZengMDPI AGMedicina1010-660X1648-91442021-07-015774774710.3390/medicina57080747Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-UpRafal Berger0Hasan Hamdoun1Rodrigo Sandoval Boburg2Medhat Radwan3Metesh Acharya4Reiner Markus Waeschle5Christian Schlensak6Aron-Frederik Popov7Petar Risteski8Department of Thoracic and Cardiovascular Surgery, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, GermanyDepartment of Thoracic and Cardiovascular Surgery, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, GermanyDepartment of Thoracic and Cardiovascular Surgery, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, GermanyDepartment of Thoracic and Cardiovascular Surgery, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, GermanyDepartment of Cardiac Surgery, Nottingham City Hospital, Hucknall Rd., Nottingham NG5 1PB, UKDepartment of Anaesthesiology, University of Goettingen, Robert-Koch-Strasse 40, 37075 Goettingen, GermanyDepartment of Thoracic and Cardiovascular Surgery, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, GermanyDepartment of Thoracic and Cardiovascular Surgery, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, GermanyDepartment of Thoracic and Cardiovascular Surgery, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany<i>Background and Objectives</i>: Over the past decade, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has developed into a mainstream treatment for refractory cardiogenic shock (CS) to maximal conservative management. Successful weaning of VA-ECMO may not be possible, and bridging with further mechanical circulatory support (MCS), such as urgent implantation of a left ventricular assist device (LVAD), may represent the only means to sustain the patient haemodynamically. In the recovery phase, many survivors are not suitably prepared physically or psychologically for the novel issues encountered during daily life with an LVAD. <i>Materials and Methods</i>: A retrospective analysis of our institutional database between 2012 and 2019 was performed to identify patients treated with VA-ECMO for CS who underwent urgent LVAD implantation whilst on MCS. Post-cardiotomy cases were excluded. QoL was assessed prospectively during a routine follow-up visit using the EuroQol-5 dimensions-5 level (EQ-5D-5L) and the Patient Health Questionnaire (PHQ-9) surveys. <i>Results</i>: Among 126 in-hospital survivors of VA-ECMO therapy due to cardiogenic shock without prior cardiac surgery, 31 (24.6%) urgent LVAD recipients were identified. In 11 (36.7%) cases, cardiopulmonary resuscitation (CPR) was performed (median 10, range 1–60 min) before initiation of VA-ECMO, and in 5 (16.7%) cases, MCS was established under CPR. Mean age at LVAD implantation was 51.7 (+/−14) years and surgery was performed after a mean 12.1 (+/−8) days of VA-ECMO support. During follow-up of 46.9 (+/−25.5) months, there were 10 deaths after 20.4 (+/−12.1) months of LVAD support. Analysis of QoL questionnaires returned a mean EQ-5D-5L score of 66% (+/−21) of societal valuation for Germany and a mean PHQ-9 score of 5.7 (+/−5) corresponding to mild depression severity. When compared with 49 elective LVAD recipients without prior VA-ECMO therapy, there was no significant difference in QoL results. <i>Conclusions</i>: Patients requiring urgent LVAD implantation under VA-ECMO support due to CS are associated with comparable quality of life without a significant difference from elective LVAD recipients. Close follow-up is required to oversee patient rehabilitation after successful initial treatment.https://www.mdpi.com/1648-9144/57/8/747LVADcardiogenic shockquality of lifefollow-up |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Rafal Berger Hasan Hamdoun Rodrigo Sandoval Boburg Medhat Radwan Metesh Acharya Reiner Markus Waeschle Christian Schlensak Aron-Frederik Popov Petar Risteski |
spellingShingle |
Rafal Berger Hasan Hamdoun Rodrigo Sandoval Boburg Medhat Radwan Metesh Acharya Reiner Markus Waeschle Christian Schlensak Aron-Frederik Popov Petar Risteski Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-Up Medicina LVAD cardiogenic shock quality of life follow-up |
author_facet |
Rafal Berger Hasan Hamdoun Rodrigo Sandoval Boburg Medhat Radwan Metesh Acharya Reiner Markus Waeschle Christian Schlensak Aron-Frederik Popov Petar Risteski |
author_sort |
Rafal Berger |
title |
Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-Up |
title_short |
Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-Up |
title_full |
Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-Up |
title_fullStr |
Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-Up |
title_full_unstemmed |
Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-Up |
title_sort |
quality of life following urgent lvad implantation for ecmo therapy in cardiogenic shock: a long-term follow-up |
publisher |
MDPI AG |
series |
Medicina |
issn |
1010-660X 1648-9144 |
publishDate |
2021-07-01 |
description |
<i>Background and Objectives</i>: Over the past decade, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has developed into a mainstream treatment for refractory cardiogenic shock (CS) to maximal conservative management. Successful weaning of VA-ECMO may not be possible, and bridging with further mechanical circulatory support (MCS), such as urgent implantation of a left ventricular assist device (LVAD), may represent the only means to sustain the patient haemodynamically. In the recovery phase, many survivors are not suitably prepared physically or psychologically for the novel issues encountered during daily life with an LVAD. <i>Materials and Methods</i>: A retrospective analysis of our institutional database between 2012 and 2019 was performed to identify patients treated with VA-ECMO for CS who underwent urgent LVAD implantation whilst on MCS. Post-cardiotomy cases were excluded. QoL was assessed prospectively during a routine follow-up visit using the EuroQol-5 dimensions-5 level (EQ-5D-5L) and the Patient Health Questionnaire (PHQ-9) surveys. <i>Results</i>: Among 126 in-hospital survivors of VA-ECMO therapy due to cardiogenic shock without prior cardiac surgery, 31 (24.6%) urgent LVAD recipients were identified. In 11 (36.7%) cases, cardiopulmonary resuscitation (CPR) was performed (median 10, range 1–60 min) before initiation of VA-ECMO, and in 5 (16.7%) cases, MCS was established under CPR. Mean age at LVAD implantation was 51.7 (+/−14) years and surgery was performed after a mean 12.1 (+/−8) days of VA-ECMO support. During follow-up of 46.9 (+/−25.5) months, there were 10 deaths after 20.4 (+/−12.1) months of LVAD support. Analysis of QoL questionnaires returned a mean EQ-5D-5L score of 66% (+/−21) of societal valuation for Germany and a mean PHQ-9 score of 5.7 (+/−5) corresponding to mild depression severity. When compared with 49 elective LVAD recipients without prior VA-ECMO therapy, there was no significant difference in QoL results. <i>Conclusions</i>: Patients requiring urgent LVAD implantation under VA-ECMO support due to CS are associated with comparable quality of life without a significant difference from elective LVAD recipients. Close follow-up is required to oversee patient rehabilitation after successful initial treatment. |
topic |
LVAD cardiogenic shock quality of life follow-up |
url |
https://www.mdpi.com/1648-9144/57/8/747 |
work_keys_str_mv |
AT rafalberger qualityoflifefollowingurgentlvadimplantationforecmotherapyincardiogenicshockalongtermfollowup AT hasanhamdoun qualityoflifefollowingurgentlvadimplantationforecmotherapyincardiogenicshockalongtermfollowup AT rodrigosandovalboburg qualityoflifefollowingurgentlvadimplantationforecmotherapyincardiogenicshockalongtermfollowup AT medhatradwan qualityoflifefollowingurgentlvadimplantationforecmotherapyincardiogenicshockalongtermfollowup AT meteshacharya qualityoflifefollowingurgentlvadimplantationforecmotherapyincardiogenicshockalongtermfollowup AT reinermarkuswaeschle qualityoflifefollowingurgentlvadimplantationforecmotherapyincardiogenicshockalongtermfollowup AT christianschlensak qualityoflifefollowingurgentlvadimplantationforecmotherapyincardiogenicshockalongtermfollowup AT aronfrederikpopov qualityoflifefollowingurgentlvadimplantationforecmotherapyincardiogenicshockalongtermfollowup AT petarristeski qualityoflifefollowingurgentlvadimplantationforecmotherapyincardiogenicshockalongtermfollowup |
_version_ |
1721191758794063872 |