Yi-Tso Cheng1, Arthur R Garan2, Joseph Sanchez3, Paul Kurlansky3, Masahiko Ando3, Marisa Cevasco3, Melana Yuzefpolskaya2, Paolo C Colombo2, Yoshifumi Naka3, Hiroo Takayama3, Koji Takeda4. 1. Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York; Department of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan. 2. Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York. 3. Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York. 4. Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York. Electronic address: ktakeda1973@gmail.com.
Abstract
BACKGROUND: The use of short-term mechanical circulatory support (ST-MCS) has increased for refractory cardiogenic shock. However, there are scant data about bridge-to-recovery patients. METHODS: We retrospectively reviewed 502 patients with cardiogenic shock who received venoarterial extracorporeal membrane oxygenation or a temporary surgical ventricular assist device as ST-MCS between 2010 and 2016. There were 178 patients (35.5%) who survived through device explantation. Of these, 149 patients (29.7%) survived to discharge and were included for analysis. The primary outcome was midterm survival without undergoing heart replacement therapy. RESULTS: In our bridge-to-recovery cohort, 101 patients (67.8%) were men, and the median age was 59 years (interquartile range, 51 to 67 years). Etiology of cardiogenic shock included postcardiotomy shock in 35.6% of patients (n = 53), allograft failure in 26.8% (n = 40), acute myocardial infarction (AMI) in 24.2% (n = 36), and other acute decompensated heart failure in 14.4% (n = 20). There were 24 major events (16.1%) recorded, including 21 patients who died and 3 patients who received heart replacement therapy during median follow-up of 306 days (interquartile range, 58.25 to 916.75 days). Overall freedom from event at 3 years was 74.2%. In subgroup analysis, AMI patients had a significantly worse freedom-from-event rate at 40.4% (p < 0.001). By univariate Cox analysis, AMI etiology (p = 0.003), length of ST-MCS (p = 0.06), blood urea nitrogen (p = 0.012), and left ventricular ejection fraction (p = 0.005) at discharge were predictors for adverse events. CONCLUSIONS: The overall midterm outcome of patients explanted from ST-MCS is favorable except for AMI patients.
BACKGROUND: The use of short-term mechanical circulatory support (ST-MCS) has increased for refractory cardiogenic shock. However, there are scant data about bridge-to-recovery patients. METHODS: We retrospectively reviewed 502 patients with cardiogenic shock who received venoarterial extracorporeal membrane oxygenation or a temporary surgical ventricular assist device as ST-MCS between 2010 and 2016. There were 178 patients (35.5%) who survived through device explantation. Of these, 149 patients (29.7%) survived to discharge and were included for analysis. The primary outcome was midterm survival without undergoing heart replacement therapy. RESULTS: In our bridge-to-recovery cohort, 101 patients (67.8%) were men, and the median age was 59 years (interquartile range, 51 to 67 years). Etiology of cardiogenic shock included postcardiotomy shock in 35.6% of patients (n = 53), allograft failure in 26.8% (n = 40), acute myocardial infarction (AMI) in 24.2% (n = 36), and other acute decompensated heart failure in 14.4% (n = 20). There were 24 major events (16.1%) recorded, including 21 patients who died and 3 patients who received heart replacement therapy during median follow-up of 306 days (interquartile range, 58.25 to 916.75 days). Overall freedom from event at 3 years was 74.2%. In subgroup analysis, AMI patients had a significantly worse freedom-from-event rate at 40.4% (p < 0.001). By univariate Cox analysis, AMI etiology (p = 0.003), length of ST-MCS (p = 0.06), blood urea nitrogen (p = 0.012), and left ventricular ejection fraction (p = 0.005) at discharge were predictors for adverse events. CONCLUSIONS: The overall midterm outcome of patients explanted from ST-MCS is favorable except for AMI patients.
Authors: Veli K Topkara; Gabriel T Sayer; Kevin J Clerkin; Omar Wever-Pinzon; Koji Takeda; Hiroo Takayama; Craig H Selzman; Yoshifumi Naka; Daniel Burkhoff; Josef Stehlik; Maryjane A Farr; James C Fang; Nir Uriel; Stavros G Drakos Journal: J Am Coll Cardiol Date: 2022-03-08 Impact factor: 24.094
Authors: Michael Ibrahim; Michael A Acker; Wilson Szeto; Jacob Gutsche; Matthew Williams; Pavan Atluri; Matthew Woods; Thomas Richards; Timothy J Gardner; Jeremy McGarvey; Mark Epler; Joyce Wald; Eduardo Rame; Edo Birati; Christian Bermudez Journal: JTCVS Open Date: 2021-07-30