GKD Anest Yoð Bak Dern Derg. 2022; 28(4): 295-299 | DOI: 10.14744/GKDAD.2022.64935

Analysis of Clinical Results for Decision Making for Short- and Long-Term Ventricular Support in INTERMACS I and II Patients

Sevinç Bayer Erdoðan, Osman Murat Baþtopçu, Murat Acarel, Halit Er
Department of Cardiovascular Surgery, University of Health Sciences, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Ýstanbul, Türkiye

Objectives: The choice of ventricular mechanical support for end-stage patients presenting with Inter-Institutional Registry for Mechanical Assisted Circulatory Support (INTERMACS) profiles I and II is still controversial. In this study, we aimed to analyze the INTERMACS I and II patients who underwent extracorporeal membrane oxygenation (ECMO) or left ventricular assist device (LVAD) as a bridge to decision.
Methods: Twenty-four patients were retrospectively analyzed as Group 1: ECMO and Group 2: LVAD implanted due to critical clinical status at INTERMACS profile I and II during 2014 and 2022.
Results: Mechanical support was ECMO in 9 patients and LVAD in 15 patients. The baseline characteristics of patients receiving ECMO and LVAD were not different in terms of comorbidities or cardiac parameters. Total mortality was 17 (70.8%) in INTERMACS I and II patients. Mortality did not differ between patients with ECMO and directly implanted LVAD. (p=0.669).
Conclusion: As both types of mechanical support will be highly mortal, in multiorgan failure with severe metabolic disorder, ECMO shall be the first choice. On the other hand, LVAD can be the therapy of choice when there is no organ failure or metabolic disorder. Additionally, the availability of organ transplantation should be considered in final decision making on a patient basis.

Keywords: End-stage heart failure, extracorporeal membrane oxygenation, inter-institutional registry for mechanical assisted circulatory support, ventricular assist device

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INTERMACS I ve II hastalarýnda Ventrikül Destek Sistemi Uygulamalarýnda Kýsa ve Uzun Dönem Destek için Karar: Klinik Sonuçlarýn Deðerlendirilmesi

Sevinç Bayer Erdoðan, Osman Murat Baþtopçu, Murat Acarel, Halit Er
Saðlýk Bilimleri Üniversitesi, Dr. Siyami Ersek Göðüs Kalp ve Damar Cerrahisi Eðitim ve Araþtýrma Hastanesi, Kalp ve Damar Cerrahisi Anabilim Dalý, Ýstanbul, Türkiye

Amaç: INTERMACS profil I, II ile takip edilen son dönem kalp yetmezliði hastalarýnda cerrahi kalp yetmezliði tedavisi seçimi hala tartýþmalýdýr. Bu çalýþmada, transplantasyona köprü olarak ekstrakorporeal membran oksijenasyonu (ECMO) veya sol ventrikül destek cihazý (LVAD) uygulanan INTERMACS I ve II hastalarýný analiz etmeyi amaçladýk.
Yöntem: 2014 ve 2022 yýllarýnda INTERMACS profili I ve II'deki kritik klinik durum nedeniyle Grup 1: ECMO ve Grup 2: LVAD implante edilmiþ olan 24 hasta geriye dönük olarak analiz edildi.
Bulgular: Mekanik destek dokuz hastada ECMO ve 15 hastada LVAD idi. Hastalar komorbiditeler veya kardiyak parametreler açýsýndan farklý deðildi. INTERMACS I-II hastasýnda toplam mortalite 17 (%70,8) idi. Mortalite, LVAD öncesi ECMO ve direkt LVAD implante edilen hastalar arasýnda farklýlýk göstermedi (p=0,669).
Sonuç: Her iki tip mekanik destek de oldukça ölümcül olacaðýndan, þiddetli metabolik bozukluðu olan çoklu organ yetmezliðinde ECMO ilk tercih olacaktýr. Öte yandan, organ yetmezliði veya metabolik bozukluk olmadýðýnda LVAD tercih edilen tedavi olabilir. Ek olarak, hasta bazýnda nihai karar verilirken organ naklinin mevcudiyeti göz önünde bulundurulmalýdýr.

Anahtar Kelimeler: Son dönem kalp yetmezliði, ekstrakorporeal membran oksijenasyonu, INTERMACS, ventriküler destek cihazý

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