Background. Extracorporeal membrane oxygenation (ECMO) is a temporary mechanical circulatory assistance, which is usually implanted under urgent conditions for critical patients. If weaning of ECMO isn’t possible, heart transplantation or implantation of a long-term mechanical circulatory assistance (LTMCA) are required. The purpose of our study is to evaluate the bridge to bridge (BTB) concept. Methods and Results. Between 1 January 2004 and 1 August 2010, 97 patients were assisted by LTMCA. The implantation was first performed for 48 patients (Bridge group) and after a period of ECMO support in 49 others (BTB group). Long-term survival was 51.6% with a mean follow-up of 30.7 months and there were no difference between the two groups. Patients of the BTB group were initially more severe and improved under ECMO support while those who don’t normalize their biological parameters died after LTMCA. Risk factors for mortality in the BTB group were total bilirubin and lactate before LTMCA and alkaline phosphatase before ECMO support. Conclusions. The BTB concept allows the implantation of a LTMCA for severe patients, for whom it was not originally envisaged, with the same long-term survival as first-line setting. ECMO, in the evolution of patients, is predictive of survival after LTMCA.
The “bridge to bridge” concept: for which patients and what purposes?
POZZI, Matteo;
2011-01-01
Abstract
Background. Extracorporeal membrane oxygenation (ECMO) is a temporary mechanical circulatory assistance, which is usually implanted under urgent conditions for critical patients. If weaning of ECMO isn’t possible, heart transplantation or implantation of a long-term mechanical circulatory assistance (LTMCA) are required. The purpose of our study is to evaluate the bridge to bridge (BTB) concept. Methods and Results. Between 1 January 2004 and 1 August 2010, 97 patients were assisted by LTMCA. The implantation was first performed for 48 patients (Bridge group) and after a period of ECMO support in 49 others (BTB group). Long-term survival was 51.6% with a mean follow-up of 30.7 months and there were no difference between the two groups. Patients of the BTB group were initially more severe and improved under ECMO support while those who don’t normalize their biological parameters died after LTMCA. Risk factors for mortality in the BTB group were total bilirubin and lactate before LTMCA and alkaline phosphatase before ECMO support. Conclusions. The BTB concept allows the implantation of a LTMCA for severe patients, for whom it was not originally envisaged, with the same long-term survival as first-line setting. ECMO, in the evolution of patients, is predictive of survival after LTMCA.
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