Durable left ventricular assist devices following temporary circulatory support on a microaxial flow pump with and without extracorporeal life support

JTCVS Open, vol. 21, pp. 168–179

Abstract

Background Circulatory support with a catheter-based microaxial flow pump (mAFP) 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) and who are not eligible for heart transplantation, durable left ventricular assist device (dLVAD) implantation is usually considered a reliable option. This study aimed to describe the outcome of dLVAD therapy following mAFP support and to identify predictors of mortality. Methods This was a retrospective analysis of data from a multicenter registry on patients who underwent dLVAD implantation following tMCS with a mAFP between January 2017 and October 2022 (n = 332) from 19 European centers. Results Patients were supported with an Impella 5.5 (n = 92), 5.0 (n = 153) or CP (n = 87) and were transitioned to a HeartWare HVAD (n = 128) or Heartmate 3 (n = 204) during the same period. One hundred and twenty-five patients (39.2%) also required extracorporeal life support before and/or during mAFP therapy. The 30-day and 1-year survival were 87.8% and 71.1%, respectively. The following risk factors for 1-year mortality were identified: age (odds ratio [OR], 1.02), specifically age over 55 years (OR, 1.09), body mass index >30 kg/m 2 (OR, 2.2), female sex (OR for male sex, 0.43), elevated total bilirubin (OR, 1.12), and low platelet count (OR, 0.996). Conclusions Based on the identified risk factors, a risk score for estimating 1-year mortality was calculated to optimize patient selection for dLVAD implantation.

Authors 33

1. Daniel Lewin corresponding

   Deutsches Herzzentrum der Charité · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany

   Department of Cardiovascular Surgery, Charité- Universitätsmedizin Berlin, Berlin, Germany

   Department of Cardiovascular Surgery, Charité– Universitätsmedizin Berlin, Berlin, Germany

2. Sebastián V. Rojas

   Heart and Diabetes Center North Rhine-Westphalia

   Affiliation as printed

   Heart and Diabetes Center, Bad Oeynhausen, North Rhine-Westphalia, Germany

3. Michael Billion

   Schüchtermann-Klinik

   Affiliation as printed

   Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany

4. Anna Lassia Meyer

   Heidelberg University · University Hospital Heidelberg

   Affiliation as printed

   Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany

5. Ivan Netuka

   Charles University · Institute of Clinical and Experimental Medicine

   Affiliation as printed

   Institute of Clinical and Experimental Medicine, Prague, Czech Republic

   Second Department of Internal Medicine, Cardiovascular Medicine, General Teaching Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic

6. Janajade Kooij

   Universitair Ziekenhuis Leuven

   Affiliation as printed

   Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium

7. Marina Pieri

   IRCCS Ospedale San Raffaele · Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

   Affiliation as printed

   Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy

8. Antonio Loforte

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

   Affiliation as printed

   Department of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola University Hospital, Bologna, Italy

   Department of Surgical Sciences, University of Turin, Turin, Italy

9. Mariusz K. Szymanski

   University Medical Center Utrecht

   Affiliation as printed

   Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands

10. Christian H. Moeller

    Rigshospitalet

    Affiliation as printed

    Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark

11. Payam Akhyari Aachen Department of Cardiothoracic Surgery

    Düsseldorf University Hospital · Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Cardiothoracic Surgery, University Hospital RTWH Aachen, Aachen, Germany

    Department of Cardiovascular Surgery, University Hospital Duesseldorf, Duesseldorf, Germany

12. Khalil Jawad

    Leipzig Heart Institute

    Affiliation as printed

    Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany

13. Ihor Krasivskyi

    University Hospital Cologne

    Affiliation as printed

    Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany

14. Bastian Schmack

    University of Duisburg-Essen

    Affiliation as printed

    Department of Cardiac Surgery, University of Essen, Essen, Germany

15. Gloria Färber

    Jena University Hospital

    Affiliation as printed

    Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany

16. Marta Medina

    Johannes Gutenberg University Mainz

    Affiliation as printed

    Department of Cardiac and Vascular Surgery, University of Mainz, Mainz, Germany

17. Assad Haneya

    University Hospital Schleswig-Holstein

    Affiliation as printed

    Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany

18. Daniel Zimpfer

    Medical University of Vienna

    Affiliation as printed

    Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria

19. Gaik Nersesian

    Deutsches Herzzentrum der Charité · German Centre for Cardiovascular Research · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany

    Department of Cardiovascular Surgery, Charité- Universitätsmedizin Berlin, Berlin, Germany

    German Center for Cardiovascular Research, Berlin, Germany

    Department of Cardiovascular Surgery, Charité– Universitätsmedizin Berlin, Berlin, Germany

20. Mehmet Oezkur

    Johannes Gutenberg University Mainz

    Affiliation as printed

    Department of Cardiac and Vascular Surgery, University of Mainz, Mainz, Germany

21. Ilija Djordjevic

    University Hospital Cologne

    Affiliation as printed

    Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany

22. Diyar Saeed

    Leipzig Heart Institute

    Affiliation as printed

    Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany

23. Julia Stein

    Deutsches Herzzentrum der Charité

    Affiliation as printed

    Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany

24. Adriaan O. Kraaijeveld

    University Medical Center Utrecht

    Affiliation as printed

    Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands

25. Finn Gustafsson

    Rigshospitalet

    Affiliation as printed

    Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark

26. Mara Scandroglio

    IRCCS Ospedale San Raffaele · Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

    Affiliation as printed

    Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy

27. Bart P. Meyns

    Universitair Ziekenhuis Leuven

    Affiliation as printed

    Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium

28. Steffen Hofmann

    Schüchtermann-Klinik

    Affiliation as printed

    Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany

29. Jan Bělohlávek

    Charles University · Institute of Clinical and Experimental Medicine

    Affiliation as printed

    Institute of Clinical and Experimental Medicine, Prague, Czech Republic

    Second Department of Internal Medicine, Cardiovascular Medicine, General Teaching Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic

30. Jan Fritz Gummert

    Heart and Diabetes Center North Rhine-Westphalia

    Affiliation as printed

    Heart and Diabetes Center, Bad Oeynhausen, North Rhine-Westphalia, Germany

31. Pia Lanmüeller

    Deutsches Herzzentrum der Charité · German Centre for Cardiovascular Research · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany

    Department of Cardiovascular Surgery, Charité- Universitätsmedizin Berlin, Berlin, Germany

    German Center for Cardiovascular Research, Berlin, Germany

    Department of Cardiovascular Surgery, Charité– Universitätsmedizin Berlin, Berlin, Germany

32. Alexander M. J. Bernhardt

    Universität Hamburg

    Affiliation as printed

    Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany

33. Evgenij V Potapov

    Deutsches Herzzentrum der Charité · German Centre for Cardiovascular Research · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany

    Department of Cardiovascular Surgery, Charité- Universitätsmedizin Berlin, Berlin, Germany

    German Center for Cardiovascular Research, Berlin, Germany

    Department of Cardiovascular Surgery, Charité– Universitätsmedizin Berlin, Berlin, Germany