title: Clinical Outcomes of Advanced Heart Failure Patients with Cardiogenic Shock Treated with Temporary Circulatory Support Before Durable LVAD Implant.
abstract: Temporary circulatory support (TCS) is used to improve hemodynamics in patients with cardiogenic shock as a bridge to durable ventricular assist device (dVAD). Data from dVAD recipients with or without TCS (extracorporeal membranous oxygenation [ECMO], n = 14; TandemHeart [TH], n = 26) were evaluated. Clinical characteristics and hemodynamics were analyzed for patients before and after TCS and compared with profile 1 (n = 29) or profile 2-3 (n = 269) patients without TCS before dVAD. Extracorporeal membranous oxygenation patients had the highest use of preoperative mechanical ventilation, vasopressors, and the highest HeartMate II risk score before dVAD (p < 0.01). Patients receiving TCS before dVAD implant had hemodynamics comparable with patients in Profiles 2-3 and superior to that of Profile 1 patients without TCS. Operative survival after dVAD was lower in patients receiving ECMO (57%) compared with Profile 1 patients receiving TH (88%), Profile 1 without TCS (82%), or Profile 2-3 patients (97%; all p < 0.01). Despite improved clinical stability with TCS, patients bridged to a dVAD have event-free survival that parallels patients in profile 1 without TCS. Our data suggest that patients requiring TCS before dVAD implant should be still classified Interagency Registry for Mechanically Assisted Circulatory Support profile 1.
authors.affiliation: From the *Heart Failure and Transplantation, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia; †School of Medicine, University of Buffalo, Buffalo, New York; ‡Department of Cardiac Surgery, University of Michigan, Ann Arbor Michigan; §Cardiac Surgery Program, Inova Fairfax Hospital, Falls Church, Virginia; ¶Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; and ‖Cardiovascular Medicine, St. Vincent Heart Center of Indiana, Indianapolis, Indiana.
authors.forename: Palak
authors.initials: P
authors.lastname: Shah
authors.forename: Sara
authors.initials: S
authors.lastname: Smith
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Haft
authors.forename: Shashank S
authors.initials: SS
authors.lastname: Desai
authors.forename: Nelson A
authors.initials: NA
authors.lastname: Burton
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Romano
authors.forename: Keith D
authors.initials: KD
authors.lastname: Aaronson
authors.forename: Francis D
authors.initials: FD
authors.lastname: Pagani
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Cowger
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome