Description:
<jats:title>Abstract</jats:title><jats:p>In patients requiring left ventricular assist device (<jats:styled-content style="fixed-case">LVAD</jats:styled-content>) support, it can be difficult to ascertain suitability for long‐term mechanical support with <jats:styled-content style="fixed-case">LVAD</jats:styled-content> and eventual transplantation. <jats:styled-content style="fixed-case">LVAD</jats:styled-content> implantation in a shocked patient is associated with increased morbidity and mortality. Interest is growing in the utilization of extracorporeal life support (<jats:styled-content style="fixed-case">ECLS</jats:styled-content>) as a bridge‐to‐bridge support for these critically unwell patients. Here, we reviewed our experience with <jats:styled-content style="fixed-case">ECLS</jats:styled-content> double bridging. We hypothesized that <jats:styled-content style="fixed-case">ECLS</jats:styled-content> double bridging would stabilize end‐organ dysfunction and reduce ventricular assist device (<jats:styled-content style="fixed-case">VAD</jats:styled-content>) implant perioperative mortality. We conducted a retrospective review of prospectively collected data for 58 consecutive patients implanted with a continuous‐flow <jats:styled-content style="fixed-case">LVAD</jats:styled-content> between <jats:styled-content style="fixed-case">J</jats:styled-content>anuary 2010 and <jats:styled-content style="fixed-case">D</jats:styled-content>ecember 2013 at <jats:styled-content style="fixed-case">T</jats:styled-content>he <jats:styled-content style="fixed-case">A</jats:styled-content>lfred Hospital, <jats:styled-content style="fixed-case">M</jats:styled-content>elbourne, Victoria, <jats:styled-content style="fixed-case">A</jats:styled-content>ustralia. Twenty‐three patients required <jats:styled-content style="fixed-case">ECLS</jats:styled-content> support pre‐<jats:styled-content style="fixed-case">LVAD</jats:styled-content> while 35 patients underwent <jats:styled-content style="fixed-case">LVAD</jats:styled-content> implantation without an <jats:styled-content style="fixed-case">ECLS</jats:styled-content> bridge. Preoperative morbidity in the <jats:styled-content style="fixed-case">ECLS</jats:styled-content> bridge group was reflected by increased postoperative intensive care duration, blood loss, blood product use, and postoperative renal failure, but without negative impact upon survival when compared with the no <jats:styled-content style="fixed-case">ECLS</jats:styled-content> group. <jats:styled-content style="fixed-case">ECLS</jats:styled-content> stabilization improved end‐organ function pre‐<jats:styled-content style="fixed-case">VAD</jats:styled-content> implant with significant improvements in hepatic and renal dysfunction. This series demonstrates that the use of <jats:styled-content style="fixed-case">ECLS</jats:styled-content> bridge to <jats:styled-content style="fixed-case">VAD</jats:styled-content> stabilizes end‐organ dysfunction and reduces <jats:styled-content style="fixed-case">VAD</jats:styled-content> implant perioperative mortality from that traditionally reported in these “crash and burn” patients.</jats:p>