Van-Khue Ton1, Rongbing Xie2, Jaime A Hernandez-Montfort3, Bart Meyns4, Takeshi Nakatani5, Masanobu Yanase6, Steve Shaw7, Stephen Pettit8, Ivan Netuka9, James Kirklin2, Daniel J Goldstein10, Jennifer Cowger11. 1. Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: kton@partners.org. 2. The University of Alabama at Birmingham, Birmingham, Alabama. 3. Cleveland Clinic Florida, Weston, Florida. 4. Gasthuisberg University Hospital, Leuven, Kingdom of Belgium. 5. National Cardiovascular Center, Osaka, Japan. 6. National Cerebral and Cardiovascular Center, Osaka, Japan. 7. Wythenshawe Hospital, Manchester, United Kingdom. 8. Royal Papworth Hospital, Cambridge, United Kingdom. 9. IKEM - Institute for Clinical and Experimental Medicine, Prague, Česko. 10. Montefiore Medical Center, New York, New York. 11. Henry Ford Health System, Detroit, Michigan.
Abstract
BACKGROUND: Patients with cardiogenic shock (CS) needing temporary circulatory support (TCS) have poor survival rates after implantation of durable ventricular assist device (dVAD). We aimed to characterize post-dVAD adverse event burden and survival rates in patients requiring pre-operative TCS. METHOD: We analyzed 13,511 adults (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS] Profiles 1-3) with continuous-flow dVADs in International Society for Heart and Lung Transplantation Registry for Mechanically Assisted Circulatory Support (2013-2017) according to the need for pre-operative TCS (n = 5,632) vs no TCS (n = 7,879). Of these, 726 (5.4%) had biventricular assist devices (BiVAD). Furthermore, we compared prevalent rates (events/100 patient-months) of bleeding, device-related infection, hemorrhagic and ischemic cerebrovascular accidents (hemorrhagic cerebral vascular accident [hCVA], and ischemic cerebral vascular accident [iCVA]) in early (<3 months) and late (≥3 months) post-operative periods. RESULTS: TCS included extracorporeal membrane oxygenation (ECMO) (n = 1,138), intra-aortic balloon pump (IABP) (n = 3,901), and other TCS (n = 593). Within 3 post-operative months, there were more major bleeding and cerebrovascular accidents (CVAs) in patients with pre-operative ECMO (events/100 patient-months rates: bleeding = 19, hCVA = 1.6, iCVA = 2.8) or IABP (bleeding = 17.3, hCVA = 1.5, iCVA = 1.5) vs no TCS (bleeding = 13.2, hCVA = 1.1, iCVA = 1.2, all p < 0.05). After 3 months, adverse events were lower and similar in all groups. Patients with ECMO had the worst short- and long-term survival rates. Patients with BiVAD had the worst survival rate regardless of need for pre-operative TCS. CVA and multiorgan failures were the common causes of death for patients with TCS and patients without TCS. CONCLUSIONS: Patients requiring TCS before dVAD had a sicker phenotype and higher rates of early post-operative adverse events than patients without TCS. ECMO was associated with very high early ischemic stroke, bleeding, and mortality. The extreme CS phenotype needing ECMO warrants a higher-level profile status, such as INTERMACS "0."
BACKGROUND:Patients with cardiogenic shock (CS) needing temporary circulatory support (TCS) have poor survival rates after implantation of durable ventricular assist device (dVAD). We aimed to characterize post-dVAD adverse event burden and survival rates in patients requiring pre-operative TCS. METHOD: We analyzed 13,511 adults (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS] Profiles 1-3) with continuous-flow dVADs in International Society for Heart and Lung Transplantation Registry for Mechanically Assisted Circulatory Support (2013-2017) according to the need for pre-operative TCS (n = 5,632) vs no TCS (n = 7,879). Of these, 726 (5.4%) had biventricular assist devices (BiVAD). Furthermore, we compared prevalent rates (events/100 patient-months) of bleeding, device-related infection, hemorrhagic and ischemic cerebrovascular accidents (hemorrhagic cerebral vascular accident [hCVA], and ischemic cerebral vascular accident [iCVA]) in early (<3 months) and late (≥3 months) post-operative periods. RESULTS:TCS included extracorporeal membrane oxygenation (ECMO) (n = 1,138), intra-aortic balloon pump (IABP) (n = 3,901), and other TCS (n = 593). Within 3 post-operative months, there were more major bleeding and cerebrovascular accidents (CVAs) in patients with pre-operative ECMO (events/100 patient-months rates: bleeding = 19, hCVA = 1.6, iCVA = 2.8) or IABP (bleeding = 17.3, hCVA = 1.5, iCVA = 1.5) vs no TCS (bleeding = 13.2, hCVA = 1.1, iCVA = 1.2, all p < 0.05). After 3 months, adverse events were lower and similar in all groups. Patients with ECMO had the worst short- and long-term survival rates. Patients with BiVAD had the worst survival rate regardless of need for pre-operative TCS. CVA and multiorgan failures were the common causes of death for patients with TCS and patients without TCS. CONCLUSIONS:Patients requiring TCS before dVAD had a sicker phenotype and higher rates of early post-operative adverse events than patients without TCS. ECMO was associated with very high early ischemic stroke, bleeding, and mortality. The extreme CS phenotype needing ECMO warrants a higher-level profile status, such as INTERMACS "0."
Authors: Tomasz K Urbanowicz; Hanna Baszyńska-Wachowiak; Anna Olasińska-Wiśniewska; Marcin Misterski; Sebastian Stefaniak; Marcin Ligowski; Marek Jemielity Journal: Kardiochir Torakochirurgia Pol Date: 2020-07-20
Authors: Jesse R Kimman; Nicolas M Van Mieghem; Henrik Endeman; Jasper J Brugts; Alina A Constantinescu; Olivier C Manintveld; Eric A Dubois; Corstiaan A den Uil Journal: Curr Heart Fail Rep Date: 2020-10
Authors: Ioannis Mastoris; Joseph E Tonna; Jinxiang Hu; Andrew J Sauer; Nicholas A Haglund; Peter Rycus; Yu Wang; William J Wallisch; Travis O Abicht; Matthew R Danter; Ryan J Tedford; James C Fang; Zubair Shah Journal: Circ Heart Fail Date: 2021-12-09 Impact factor: 8.790