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- Title
Bridging to a Long‐Term Ventricular Assist Device With Short‐Term Mechanical Circulatory Support.
- Authors
Kurihara, Chitaru; Kawabori, Masashi; Sugiura, Tadahisa; Critsinelis, Andre C.; Wang, Suwei; Cohn, William E.; Civitello, Andrew B.; Frazier, O. H.; Morgan, Jeffrey A.
- Abstract
Abstract: Implanting short‐term mechanical circulatory support (MCS) devices as a bridge‐to‐decision is increasingly popular. However, outcomes have not been well studied in patients who receive short‐term MCS before receiving long‐term left ventricular assist device (LVAD) support. We analyzed outcomes in our single‐center experience with long‐term continuous‐flow (CF)‐LVAD recipients with pre‐implantation short‐term MCS. From November 2003 through March 2016, 526 patients (mean age, 54.7 ± 13.5 years) with chronic heart failure (mean ejection fraction, 21.7 ± 3.6%) underwent implantation of either the HeartMate II (n = 403) or the HeartWare device (n = 123). Before implantation, 269 patients received short‐term MCS with the TandemHeart, the Impella 2.5/5.0, an intra‐aortic balloon pump (IABP), venoarterial extracorporeal membrane oxygenation (VA‐ECMO), or the CentriMag. The short‐term MCS patients were compared with the CF‐LVAD–only patients regarding preoperative demographics, incidence of postoperative complications, and long‐term survival. The 269 patients received the following short‐term MCS devices: 57 TandemHeart, 27 Impella, 172 IABP, 12 VA‐ECMO, and 1 CentriMag. Survival at 30 days, 6 months, 1 year, and 2 years was 94.2, 87.2, 79.4, and 72.4%, respectively, for CF‐LVAD–only patients versus 91.0, 78.1, 73.4, and 65.6%, respectively, for short‐term MCS + CF‐LVAD patients (P = 0.17). Within the short‐term MCS group, survival at 24 months was poorest for patients supported with VA‐ECMO or the TandemHeart (P = 0.03 for both), and survival across all four time points was poorest for patients supported with VA‐ECMO (P = 0.02). Short‐term MCS was not an independent predictor of mortality in multivariate Cox regression models (hazard ratio = 1.12, 95% confidence interval = 0.84–1.49, P = 0.43). In conclusion, we found that using short‐term MCS therapy—except for VA‐ECMO—as a bridge to long‐term CF‐LVAD support was not associated with poorer survival.
- Subjects
HEART assist devices; HEART failure; CHRONIC diseases; ARTIFICIAL implants; EXTRACORPOREAL membrane oxygenation
- Publication
Artificial Organs, 2018, Vol 42, Issue 6, p589
- ISSN
0160-564X
- Publication type
Article
- DOI
10.1111/aor.13112