Clinical Outcomes of Advanced Heart Failure Patients with Cardiogenic Shock Treated with Temporary Circulatory Support Before Durable LVAD Implant. Issue 1 (January 2016)

• Record Type: Journal Article
• Authors: Shah, Palak; Smith, Sara; Haft, Jonathan W.; Desai, Shashank S.; Burton, Nelson A.; Romano, Matthew A.; Aaronson, Keith D.; Pagani, Francis D.; Cowger, Jennifer A.
• Is Part Of: ASAIO journal. Volume 62:Issue 1(2016)
• Publication Date: 2016-01
• Subjects: temporary circulatory support -- cardiogenic shock -- ventricular assist device -- intraaortic balloon pump -- extracorporeal membranous oxygenation; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000000309
• Languages: English
• ISSNs: 1058-2916

Abstract

Abstract : Temporary circulatory support (TCS) is used to improve hemodynamics in patients with cardiogenic shock as a bridge to durable ventricular assist device (dVAD). Data from dVAD recipients with or without TCS (extracorporeal membranous oxygenation [ECMO], n = 14; TandemHeart [TH], n = 26) were evaluated. Clinical characteristics and hemodynamics were analyzed for patients before and after TCS and compared with profile 1 (n = 29) or profile 2–3 (n = 269) patients without TCS before dVAD. Extracorporeal membranous oxygenation patients had the highest use of preoperative mechanical ventilation, vasopressors, and the highest HeartMate II risk score before dVAD ( p < 0.01). Patients receiving TCS before dVAD implant had hemodynamics comparable with patients in Profiles 2–3 and superior to that of Profile 1 patients without TCS. Operative survival after dVAD was lower in patients receiving ECMO (57%) compared with Profile 1 patients receiving TH (88%), Profile 1 without TCS (82%), or Profile 2–3 patients (97%; all p < 0.01). Despite improved clinical stability with TCS, patients bridged to a dVAD have event-free survival that parallels patients in profile 1 without TCS. Our data suggest that patients requiring TCS before dVAD implant should be still classified Interagency Registry for Mechanically Assisted Circulatory Support profile 1.