Transition from temporary microaxial left ventricular assist devices to durable mechanical circulatory support systems

European Heart Journal, vol. 44

Abstract

Abstract Background Circulatory support with a catheter-based microaxial temporary left ventricular assist device (tLVAD) plays a major role in the treatment of severe cardiogenic shock. In most patients who fail to recover while on temporary mechanical circulatory support (tMCS), durable left ventricular assist device (dLVAD) therapy is usually considered a reliable option. The aim of this study was to identify outcome predictors after the transition from a catheter-based microaxial tLVAD to dLVAD. Methods This is a retrospective analysis of data from a multicentre registry on patients who were transitioned from a catheter-based microaxial tLVAD to a dLVAD between 01/2017 and 10/2022 (n=341) from 19 European high-volume centres with regard to survival and outcome up to one year after dLVAD implantation. Results Patients were supported with an Impella 5.5 (92), 5.0 (155), CP (92), or 2.5 (2) and transitioned to Heartmate 3 (205), a HeartWare HVAD (129) or EXCOR VAD (7) during the same period. The Impella was implanted via the axillary artery in 245 (71.8%), the femoral artery in 93 (27.3%), and via direct access to the aorta in three (0.9%) patients. One hundred and thirty-three (40.5%) patients additionally required extracorporeal life support before and/or during Impella therapy. The aetiology of cardiogenic shock necessitating tMCS was most commonly acute myocardial infarction (31.7%), followed by acute decompensation of ischaemic (28.4%) or dilated cardiomyopathy (27.0%). The 30-day and 1-year survival were 87% and 70%, respectively. The uni- and multivariable analysis included 312 patients with an at least 1-year follow-up or death within the first year after dLVAD implantation. The following risk factors for 1-year mortality were identified: age (OR 1.02), specifically age over 55 years (OR 1.09), BMI >30 kg/m² (OR 2.2), female sex (OR for male sex 0.4), as well as elevated total bilirubin (OR 1.13) and low platelet counts (OR 0.996). Conclusions During preoperative conditioning, efforts should be undertaken towards normalising platelet counts and liver function. Using the identified risk factors as a basis, we created a risk score to estimate 1-year mortality to optimise patient selection for dLVAD implantation, with the aim of improving the outcome in this critical patient population.Normogram 1y-mortality prediction scoreCIF death grouped by quartiles of score

Authors 13

1. Mariusz K. Szymanski

   University Medical Center Utrecht

   Affiliation as printed

   University Medical Center Utrecht, Cardiology , Utrecht , Netherlands (The)

2. Diyar Saeed

   Leipzig Heart Institute

   Affiliation as printed

   Heart Center of Leipzig, Cardiac Surgery , Leipzig , Germany

3. A M Scandroglio

   IRCCS Ospedale San Raffaele

   Affiliation as printed

   IRCCS San Raffaele Hospital, Anaesthesia and Intensive Care , Milan , Italy

4. Payam Akhyari Aachen Cardiothoracic Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   RWTH University Hospital Aachen, Cardiothoracic Surgery , Aachen , Germany

5. Bart P. Meyns

   Universitair Ziekenhuis Leuven

   Affiliation as printed

   University Hospitals (UZ) Leuven, Cardiac Surgery , Leuven , Belgium

6. Antonio Loforte

   IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola · University of Bologna

   Affiliation as printed

   University Hospital of Bologna S. Orsola-Malpighi Polyclinic, Cardiac Surgery , Bologna , Italy

7. Mehmet Oezkur

   University Medical Center of the Johannes Gutenberg University Mainz

   Affiliation as printed

   University Medical Center Mainz, Cardiac and Vascular Surgery , Mainz , Germany

8. Daniel Zimpfer

   Medical University of Vienna

   Affiliation as printed

   Medical University of Vienna, Cardiac Surgery , Vienna , Austria

9. Finn Gustafsson

   Copenhagen University Hospital · Rigshospitalet

   Affiliation as printed

   Rigshospitalet - Copenhagen University Hospital, Cardiology , Copenhagen , Denmark

10. Michael Billion

    Schüchtermann-Klinik

    Affiliation as printed

    Schuechtermann-Clinic, Cardiac Surgery , Bad Rothenfelde , Germany

11. Jan Bělohlávek

    Charles University

    Affiliation as printed

    Charles University of Prague, Internal Medicine, Cardiovascular Medicine , Prague , Czechia

12. Alexander M. J. Bernhardt

    Universität Hamburg

    Affiliation as printed

    University Heart Centre Hamburg, Cardiovascular Surgery , Hamburg , Germany

13. Evgenij V Potapov

    Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Charité - University Medicine Berlin, Cardiothoracic and Vascular Surgery , Berlin , Germany