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. 2022 Nov;37(11):3576-3583.
doi: 10.1111/jocs.16942. Epub 2022 Sep 19.

Impact of preoperative Impella support on destination left ventricular assist device outcomes

Timothy J George  1 , Justin M Schaffer  1 , Katherine B Harrington  1 , Talia G Meidan  1 , John Michael DiMaio  1 , Nitin Kabra  1 , David A Rawitscher  1 , Aasim Afzal  1
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Impact of preoperative Impella support on destination left ventricular assist device outcomes

Timothy J George et al. J Card Surg. 2022 Nov.

Abstract

Background: Although left ventricular assist device (LVAD) implantation is associated with improved heart failure survival, the impact of pre-implantation Impella support on outcomes is unknown. We undertook this study to evaluate the impact of preoperative Impella support on LVAD outcomes.

Methods: We conducted a retrospective review of all Heartmate 3 LVAD implants. Primary stratification was by the need for preoperative Impella support with the 5.0/5.5 device. Longitudinal survival was assessed by the Kaplan-Meier method. Multivariable Cox proportional hazards regression models were developed to evaluate mortality. Secondary outcomes included changes in laboratory values during Impella support.

Results: From 2017 to 2021, 87 patients underwent LVAD implantation. Sixteen were supported with a single inotrope, 36 with dual inotropes, 27 with Impella, and 3 with extracorporeal membrane oxygenation (ECMO). When stratified by the need for Impella, there was no difference in survival at 30-days (98.3 [88.2-99.8]% vs. 96.3 [76.5-99.5]%, p = .59), 1-year (91.0 [79.8-96.2] vs. 74.9 [51.7-88.2], p = .10), or at 2 years (87.9 [74.3-94.5] vs. 74.9 [51.7-88.2], p = .15). On multivariable modeling, the need for preoperative Impella was not associated with an increased hazard of 1-year (1.24 [0.23-6.73], p = .81) or 2-year mortality (1.05 [0.21-5.19], p = .95). After 7 (5-10) days of Impella support, recipient creatinine (p < .01), creatinine clearance (p = .02), and total bilirubin (p = .053) improved and lactic acidosis resolved (p < .01).

Conclusions: Preoperative Impella support is not associated with increased short or long-term mortality but is associated with improved renal and hepatic function as well as total body perfusion before LVAD implantation.

Keywords: cardiovascular pathology; perfusion; transplant.

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References

REFERENCES

    1. Molina EJ, Shah P, Kiernan MS, et al. The Society of Thoracic Surgeon Intermacs 2020 annual report. Ann Thorac Surg. 2021;111:778-792.
    1. Mehra MR, Naka Y, Uriel N, et al. A fully magnetically levitated circulatory pump for advanced heart failure. N Engl J Med. 2017;376:440-450.
    1. Mehra MR, Goldstein DJ, Uriel N, et al. Two-year outcomes with a magnetically levitated cardiac pump in heart failure. N Engl J Med. 2018;378:1386-1395.
    1. Mehra MR, Uriel N, Naka Y, et al. A fully magnetically levitated left ventricular assist device-final report. N Engl J Med. 2019;380:1618-1627.
    1. Zhang B, Guo S, Ning J, Li Y, Liu Z. Continuous-flow left ventricular assist devices versus orthotopic heart transplantation: a systematic review and meta-analysis. Ann Cardiothorac Surg. 2021;10(2):209-220.

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