{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:36:06Z","timestamp":1792798566507,"version":"4.5.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T00:00:00Z","timestamp":1735862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100016988","name":"Chonnam National University Hospital Biomedical Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016988","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Korea Health Technology R&D"},{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ministry of Health & Welfare","award":["HI22C178400"],"award-info":[{"award-number":["HI22C178400"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>The long-term effects of early left ventricular (LV) unloading after venoarterial extracorporeal membrane oxygenation (VA-ECMO) remain unclear.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>The EARLY-UNLOAD trial was a single-centre, investigator-initiated, open-label, randomized clinical trial involving 116 patients with cardiogenic shock (CS) undergoing VA-ECMO. The patients were randomly assigned to undergo either early routine LV unloading by transseptal left atrial cannulation within 12\u2005h after randomization or the conventional approach, which permitted rescue transseptal cannulation in case of an increased LV afterload. The pre-specified secondary endpoints at 1 year included all-cause mortality, cardiac mortality, non-cardiac mortality, rehospitalization for heart failure (HF), and the composite of all-cause mortality or rehospitalization for HF. At 1 year, data for 114 of 116 patients (98.3%) were available for analysis. All-cause death had occurred in 33 of 58 patients (56.9%) in early group and 32 of 56 patients (57.1%) in conventional group {hazard ratio [HR], 0.97 [95% confidence interval (CI), 0.60 to 1.58], P = 0.887}. There was no significant difference in cardiac or non-cardiac mortality. Among 61 survivors at 30 days, the incidence of rehospitalization for HF at 1 year was comparable between two groups [HR, 1.17 (95% CI 0.43 to 3.24), P = 0.758]. The incidence of the composite outcome of all-cause mortality or rehospitalization for HF also did not differ between the groups [HR, 1.01 (95% CI 0.69 to 1.76), P = 0.692].<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Among patients with CS undergoing VA-ECMO, early routine LV unloading did not improve clinical outcomes at 1 year of follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Registration<\/jats:title>\n                  <jats:p>ClinicalTrials.gov: NCT04775472<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjacc\/zuae150","type":"journal-article","created":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T12:56:48Z","timestamp":1735909008000},"page":"203-211","source":"Crossref","is-referenced-by-count":2,"title":["Early left ventricular unloading after venoarterial extracorporeal membrane oxygenation: 1-year outcomes of the EARLY-UNLOAD randomized clinical trial"],"prefix":"10.1093","volume":"14","author":[{"given":"Yongwhan","family":"Lim","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,","place":["South Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Chul","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,","place":["South Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2337-7826","authenticated-orcid":false,"given":"Seung Hun","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,","place":["South Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seongho","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,","place":["South Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon Ho","family":"Ahn","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,","place":["South Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dae Young","family":"Hyun","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,","place":["South Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung Hoon","family":"Cho","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,","place":["South Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong Hun","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Chonnam National University Hospital, Chonnam National University Medical School , 42 Jebong-ro, Dong-gu, Gwangju 61469 ,","place":["South 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