Propensity score‐based analysis of 30‐day survival in cardiogenic shock patients supported with different microaxial left ventricular assist devices. Issue 11 (30th August 2021)

• Record Type: Journal Article
• Authors: Nersesian, Gaik; Potapov, Evgenij V.; Nelki, Vivian; Stein, Julia; Starck, Christoph; Falk, Volkmar; Schoenrath, Felix; Krackhardt, Florian; Tschöpe, Carsten; Spillmann, Frank
• Is Part Of: Journal of cardiac surgery. Volume 36:Issue 11(2021)
• Page Start: 4141
• Page End: 4152
• Publication Date: 2021-08-30
• Subjects: cardiogenic shock -- Impella -- LVAD; Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.15932
• Languages: English
• ISSNs: 0886-0440

Abstract

Abstract: Background and methods: Microaxial left ventricular assist devices are used increasingly for treating cardiogenic shock. We compared the short‐term outcome of patients supported with different microaxial devices for cardiogenic shock. A retrospective propensity score‐adjusted analysis was performed in cardiogenic shock patients treated with either the Impella CP ( n = 64) or the Impella 5.0/5.5 ( n = 62) at two tertiary cardiac care centers between 1/14 and 12/19. Results: Patients in the Impella CP group were significantly older (69.6 ± 10.7 vs. 58.7 ± 11.9 years, p = .001), more likely in INTERMACS profile 1 (76.6% vs. 50%, p = .003) and post‐C‐reactive protein (CPR) (36% vs. 13%, p = .006). The median support time was 2.0 days [0.0, 5.3] in the CP group vs. 8.5 days [4.3, 15.8] in the 5.0/5.5 group ( p < .001). The unadjusted 30‐day survival was significantly higher in the Impella 5.0/5.5 group (58% vs. 36%, p = .021, odds ratio [OR] for 30‐day survival on Impella 5.0/5.5 was 3.68 [95% confidence interval [CI]: [1.46–9.90]], p = .0072). After adjustment, the 30‐day survival was similar for both devices (OR: 1.23, 95% CI: [0.34–4.18], p = .744). Lactate levels above 8 mmol/L and preoperative CPR were associated with a significant mortality increase in both cohorts (OR: 10.7, 95% CI: [3.45–47.34], p < .001; OR: 13.2, 95% CI: [4.28–57.89], p < .001, respectively). Conclusion: Both Impella devices offer a similar effect with regard to survival in cardiogenic shock patients. Preoperative CPR or lactate levels exceeding 8 mmol/L immediately before implantation have a poor prognosis on Impella CP and Impella 5.0/5.5.