Cohort grouping and surgical procedure

A durable LVAD was implanted as the primary mechanical support device in 115 patients (primary group), whereas the remaining 43 underwent durable LVAD implantation as the bridge from central ECLS (bridge group). In the bridge group, the mean duration of central ECLS was 52.4 ± 44.4 days (range 3–173 days). Initial central ECLS was an extracorporeal LVAD in 30 (69.8%) patients, extracorporeal bilateral ventricular assist device in 7 (16.3%), and extracorporeal membrane oxygenation by central cannulations in 6 (1%).

The durable LVAD was implanted by the median sternotomy approach in all patients. In the bridge group, the left ventricular apex cuff of the central ECLS was completely removed to replace the cuff of the HeartMate II or HeartMate 3. Tricuspid annuloplasty was performed by using a prosthetic ring in patients with moderate or more tricuspid regurgitation preoperatively (n = 45). Aortic valve plasty was performed by the Park’s stich [11] in patients with mild or more aortic valve regurgitation preoperatively (n = 19). In patients who failed to wean off cardiopulmonary bypass under durable LVAD support owing to poor RV function, mechanical RV support was added by cannulations into the main pulmonary artery and right atrium via the femoral vein, which was connected to an extracorporeal membrane oxygenation circuit (n = 4).