Short- and long-term survival of patients transferred to a tertiary care center on temporary extracorporeal circulatory support.
BACKGROUND
Mechanical circulatory support (MCS) with temporary, extracorporeal assist devices restores hemodynamics in patients with refractory cardiogenic shock. These devices are frequently used in community hospitals, with subsequent referral to tertiary care centers. We sought to determine the outcomes of such referrals and identify prognostic variables that may influence management decisions.


METHODS
We performed a single-institution retrospective review of 59 consecutive patients transferred on temporary, extracorporeal MCS from 1997 to 2008. Demographics, medical history, laboratory data, and clinical status were obtained, with survival determined from the medical record and the Social Security Death Index. Univariable and multivariable analysis were performed and survival estimates were determined using the Kaplan-Meier method.


RESULTS
Median age was 49.6 years (range, 14 to 77 years). Forty-five patients (76%) were supported for postcardiotomy failure, and 34 (58%) required biventricular support. Twenty-five (42%) survived to hospital discharge, 11 after cardiac recovery (44%), 9 with long-term implantable MCS devices (39%), and 5 after heart transplantation (22%). Eight patients discharged with implantable MCS devices underwent heart transplantation and 1 remains alive on long-term implantable MCS support. Survival was 42% +/- 6% at 1 year and 38% +/- 6% at 5 years. Age and renal function were independent predictors of death.


CONCLUSIONS
Nearly half of all patients transferred on temporary extracorporeal MCS survive to discharge. Most of the long-term survivors received a heart transplant. Age and renal function were independent predictors of death, suggesting that survival is maximized by considering eligibility for cardiac transplantation.
Haft
Jonathan W
JW
Section of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA. haft@umich.edu
Pagani
Francis D
FD
Romano
Matthew A
MA
Leventhal
Christina L
CL
Dyke
D Bradley
DB
Matthews
Jennifer C
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008824:Michigan; D008875:Middle Aged; D015999:Multivariate Analysis; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D017741:Survivors / Q000706:statistics & numerical data; D055815:Young Adult
Am Heart J. 2006 Sep;152(3):469.e1-8
16923414
J Thorac Cardiovasc Surg. 2007 Jul;134(1):199-203
17599509
N Engl J Med. 2007 Aug 30;357(9):885-96
17761592
Circulation. 2002 Sep 24;106(12 Suppl 1):I203-6
12354734
Ann Thorac Surg. 1996 Jan;61(1):301-4; discussion 311-3
8561594
J Heart Lung Transplant. 2005 Jun;24(6):764-8
15949738
Ann Epidemiol. 2002 Oct;12(7):462-8
12377423
J Card Surg. 1999 Jul-Aug;14(4):288-93
10874615
J Heart Lung Transplant. 2003 Jun;22(6):653-62
12821162
Circulation. 2007 Aug 7;116(6):606-12
17646586
J Am Coll Cardiol. 2008 Nov 4;52(19):1584-8
19007597
ASAIO J. 2006 Jul-Aug;52(4):445-9
16883126