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Ann Thorac Surg 2006;82:28-33
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Outcome Evaluation of the Bridge to Bridge Concept in Patients With Cardiogenic Shock

^a Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
^b Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria
^c Department of Anesthesiology and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria
^d Department of General and Transplantation Surgery, Innsbruck Medical University, Innsbruck, Austria

Accepted for publication February 27, 2006.

^_* Address correspondence to Dr Hoefer, Department of Cardiac Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria; (Email: daniel.hoefer{at}uibk.ac.at).

BACKGROUND: Patients with cardiogenic shock can be stabilized by percutaneous implantation of extracorporeal membrane oxygenation (ECMO). If weaning from ECMO is impossible, the implantation of a ventricular assist device (VAD) is required. Patients either go for recovery of myocardial function (bridge to recovery) or for heart transplantation (bridge to transplant).

METHODS: One hundred thirty-one patients were supported with ECMO between March 1995 and November 2005. Reasons for ECMO implantation were acute heart failure, acute or chronic heart failure, and postcardiotomy heart failure. In 28 patients, subsequent VAD implantation was necessary (bridge to bridge concept).

RESULTS: Fourteen bridge to bridge patients (50%) became long-time survivors with a mean follow-up of 39 months. Risk factors for mortality were status post–cardiopulmonary resuscitation and elevated lactate and bilirubin levels before VAD implantation. Complications after ECMO and VAD implantation were bleeding and thromboembolic events. The most common cause of death was multiorgan failure.

CONCLUSIONS: Bridge to bridge is a successful concept for selected patients with cardiogenic shock. During ECMO support, patients can be evaluated for comorbidities. For patients with a combination of risk factors (status post–cardiopulmonary resuscitation, elevated lactate levels, and impaired liver function), VAD implantation should be considered very carefully.

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