Temporal Trends in Left Ventricular Mechanical Unloading With Venoarterial Extracorporeal Membrane Oxygenation.

Cardiogenic shock is associated with high risk of short-term mortality, reaching ≈50% even in the contemporary era. 1 Schrage B Becher PM Bernhardt A Bezerra H Blankenberg S Brunner S Colson P Cudemus Deseda G Dabboura S Eckner D Eden M Eitel I Frank D Frey N Funamoto M Goßling A Graf T Hagl C Kirchhof P Kupka D Landmesser U Lipinski J Lopes M Majunke N Maniuc O McGrath D Möbius-Winkler S Morrow DA Mourad M Noel C Nordbeck P Orban M Pappalardo F Patel SM Pauschinger M Pazzanese V Reichenspurner H Sandri M Schulze PC H G Schwinger R Sinning JM Aksoy A Skurk C Szczanowicz L Thiele H Tietz F Varshney A Wechsler L Westermann D Left ventricular unloading is associated with lower mortality in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation: results from an international, multicenter cohort study. Circulation. 2020; 142: 2095-2106 Crossref PubMed Scopus (204) Google Scholar Mechanical circulatory support (MCS) using venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used in patients with cardiogenic shock. 1 Schrage B Becher PM Bernhardt A Bezerra H Blankenberg S Brunner S Colson P Cudemus Deseda G Dabboura S Eckner D Eden M Eitel I Frank D Frey N Funamoto M Goßling A Graf T Hagl C Kirchhof P Kupka D Landmesser U Lipinski J Lopes M Majunke N Maniuc O McGrath D Möbius-Winkler S Morrow DA Mourad M Noel C Nordbeck P Orban M Pappalardo F Patel SM Pauschinger M Pazzanese V Reichenspurner H Sandri M Schulze PC H G Schwinger R Sinning JM Aksoy A Skurk C Szczanowicz L Thiele H Tietz F Varshney A Wechsler L Westermann D Left ventricular unloading is associated with lower mortality in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation: results from an international, multicenter cohort study. Circulation. 2020; 142: 2095-2106 Crossref PubMed Scopus (204) Google Scholar VA-ECMO is a high-output MCS that can increase end-organ perfusion and improve tissue oxygenation. 1 Schrage B Becher PM Bernhardt A Bezerra H Blankenberg S Brunner S Colson P Cudemus Deseda G Dabboura S Eckner D Eden M Eitel I Frank D Frey N Funamoto M Goßling A Graf T Hagl C Kirchhof P Kupka D Landmesser U Lipinski J Lopes M Majunke N Maniuc O McGrath D Möbius-Winkler S Morrow DA Mourad M Noel C Nordbeck P Orban M Pappalardo F Patel SM Pauschinger M Pazzanese V Reichenspurner H Sandri M Schulze PC H G Schwinger R Sinning JM Aksoy A Skurk C Szczanowicz L Thiele H Tietz F Varshney A Wechsler L Westermann D Left ventricular unloading is associated with lower mortality in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation: results from an international, multicenter cohort study. Circulation. 2020; 142: 2095-2106 Crossref PubMed Scopus (204) Google Scholar Although VA-ECMO support improves systemic perfusion, it may lead to unfavorable left ventricle (LV) hemodynamics secondary to retrograde aortic flow, which causes increased afterload and increase in myocardial oxygen consumption. 1 Schrage B Becher PM Bernhardt A Bezerra H Blankenberg S Brunner S Colson P Cudemus Deseda G Dabboura S Eckner D Eden M Eitel I Frank D Frey N Funamoto M Goßling A Graf T Hagl C Kirchhof P Kupka D Landmesser U Lipinski J Lopes M Majunke N Maniuc O McGrath D Möbius-Winkler S Morrow DA Mourad M Noel C Nordbeck P Orban M Pappalardo F Patel SM Pauschinger M Pazzanese V Reichenspurner H Sandri M Schulze PC H G Schwinger R Sinning JM Aksoy A Skurk C Szczanowicz L Thiele H Tietz F Varshney A Wechsler L Westermann D Left ventricular unloading is associated with lower mortality in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation: results from an international, multicenter cohort study. Circulation. 2020; 142: 2095-2106 Crossref PubMed Scopus (204) Google Scholar The concepts of LV venting and unloading have been introduced in patients evaluated for MCS. LV venting usually refers to techniques that passively reduce LV filling pressures, and LV unloading refers to techniques that actively reduce pressure and volume loads and reduced myocardial oxygen consumption. The unfavorable effects with VA-ECMO may be mitigated with concomitant LV mechanical unloading (MU) techniques, such as intra-aortic balloon pump (IABP) or the Impella microaxial flow pump. 1 Schrage B Becher PM Bernhardt A Bezerra H Blankenberg S Brunner S Colson P Cudemus Deseda G Dabboura S Eckner D Eden M Eitel I Frank D Frey N Funamoto M Goßling A Graf T Hagl C Kirchhof P Kupka D Landmesser U Lipinski J Lopes M Majunke N Maniuc O McGrath D Möbius-Winkler S Morrow DA Mourad M Noel C Nordbeck P Orban M Pappalardo F Patel SM Pauschinger M Pazzanese V Reichenspurner H Sandri M Schulze PC H G Schwinger R Sinning JM Aksoy A Skurk C Szczanowicz L Thiele H Tietz F Varshney A Wechsler L Westermann D Left ventricular unloading is associated with lower mortality in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation: results from an international, multicenter cohort study. Circulation. 2020; 142: 2095-2106 Crossref PubMed Scopus (204) Google Scholar ,2 Grandin EW Nunez JI Willar B Kennedy K Rycus P Tonna JE Kapur NK Shaefi S Garan AR. Mechanical left ventricular unloading in patients undergoing venoarterial extracorporeal membrane oxygenation. J Am Coll Cardiol. 2022; 79: 1239-1250 Crossref PubMed Scopus (51) Google Scholar Data from observational studies suggest that LV-MU may improve outcomes in patients on VA-ECMO. 1 Schrage B Becher PM Bernhardt A Bezerra H Blankenberg S Brunner S Colson P Cudemus Deseda G Dabboura S Eckner D Eden M Eitel I Frank D Frey N Funamoto M Goßling A Graf T Hagl C Kirchhof P Kupka D Landmesser U Lipinski J Lopes M Majunke N Maniuc O McGrath D Möbius-Winkler S Morrow DA Mourad M Noel C Nordbeck P Orban M Pappalardo F Patel SM Pauschinger M Pazzanese V Reichenspurner H Sandri M Schulze PC H G Schwinger R Sinning JM Aksoy A Skurk C Szczanowicz L Thiele H Tietz F Varshney A Wechsler L Westermann D Left ventricular unloading is associated with lower mortality in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation: results from an international, multicenter cohort study. Circulation. 2020; 142: 2095-2106 Crossref PubMed Scopus (204) Google Scholar ,2 Grandin EW Nunez JI Willar B Kennedy K Rycus P Tonna JE Kapur NK Shaefi S Garan AR. Mechanical left ventricular unloading in patients undergoing venoarterial extracorporeal membrane oxygenation. J Am Coll Cardiol. 2022; 79: 1239-1250 Crossref PubMed Scopus (51) Google Scholar However, few data are available describing contemporary practice patterns regarding LV-MU in patients who require VA-ECMO support.