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. 2024 Jul 31:21:168-179.
doi: 10.1016/j.xjon.2024.06.021. eCollection 2024 Oct.

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

Daniel Lewin  1   2 , Sebastian V Rojas  3 , Michael Billion  4 , Anna L Meyer  5 , Ivan Netuka  6   7 , Janajade Kooij  8 , Marina Pieri  9 , Antonio Loforte  10   11 , Mariusz K Szymanski  12 , Christian H Moeller  13 , Payam Akhyari  14   15 , Khalil Jawad  16 , Ihor Krasivskyi  17 , Bastian Schmack  18 , Gloria Färber  19 , Marta Medina  20 , Assad Haneya  21 , Daniel Zimpfer  22 , Gaik Nersesian  1   2   23 , Mehmet Oezkur  20 , Ilija Djordjevic  17 , Diyar Saeed  16 , Julia Stein  1 , Adriaan O Kraaijeveld  12 , Finn Gustafsson  13 , Mara Scandroglio  9 , Bart Meyns  8 , Steffen Hofmann  4 , Jan Belohlavek  6   7 , Jan F Gummert  3 , Pia Lanmueller  1   2   23 , Alexander M Bernhardt  24 , Evgenij V Potapov  1   2   23
Affiliations

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

Daniel Lewin et al. JTCVS Open. .

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/m2 (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.

Keywords: Impella; LVAD; cardiogenic shock; mechanical circulatory support; outcome.

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Conflict of interest statement

M.O. is a member of the advisory board for A biomed. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

None
Cumulative incidence function of exitus on dLVAD with transplantation and weaning.
Figure 1
Figure 1
CONSORT diagram. mAFP, Microaxial flow pump; VA-ECLS, venoarterial extracorporeal life support; dLVAD, durable left ventricular assist device; tMCS, temporary mechanical circulatory support.
Figure 2
Figure 2
Cumulative incidence function with 95% confidence intervals of exitus on durable left ventricular assist device (dLVAD) (blue) with transplantation (red) and weaning (green) as competing risks.
Figure 3
Figure 3
Cumulative incidence function with 95% confidence intervals of stroke (blue) with durable left ventricular assist device (dLVAD) explantation (red) as a competing risk.
Figure 4
Figure 4
Nomogram illustrating the 1-year mortality estimate calculation. Depending on the values for the 5 risk factors—body mass index >30 kg/m2 (yes = 1, no = 0), total bilirubin in mg/dL, male sex (yes = 1, no = 0), platelet count × 10³/μL, age in years—the number of points for each of these can be read in the upper row. The total amount of points can then be converted into the linear predictor below, which in turn is used to estimate the probability of 1-year mortality in the row below. BMI, Body mass index.
Figure E1
Figure E1
Calibration plot.
See this image and copyright information in PMC

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