title: Outcomes of Patients Receiving Temporary Circulatory Support Before Durable Ventricular Assist Device.
abstract: BACKGROUND
  Temporary circulatory support (TCS) is used to stabilize patients in critical cardiogenic shock and bridge patients to a durable ventricular assist device (VAD). Whether TCS confers increased risk at the time of VAD implant is unknown.
  
  
  METHODS
  Prospectively collected data from five institutions was retrospectively reviewed. All profile 1 through profile 3 patients implanted with a continuous-flow VAD (n = 804) were categorized into three groups: TCS (n = 68); non-TCS profile 1 (n = 70); and non-TCS profile 2-3 (n = 666).
  
  
  RESULTS
  End-organ function and hemodynamics were worse before TCS than in non-TCS profile 1 patients: creatinine (1.7 ± 0.1 mg/dL versus 1.3 ± 0.06 mg/dL, p = 0.003); and right atrial pressure (16 ± 0.8 mm Hg versus 13 ± 1.1 mm Hg, p = 0.048). The TCS restored cardiac output before durable VAD (4.9 ± 0.2 L/min), and was comparable to profile 2-3 patients (4.3 ± 0.05 L/min) and better than profile 1 patients (4.0 ± 0.2 L/min, p = 0.002). Markers of hepatic function such as bilirubin were impaired before VAD in TCS and profile 1 patients (2.0 ± 0.2 mg/dL) compared with profile 2 and 3 patients (1.1 ± 0.03, p < 0.001). The incidence of postoperative right ventricular failure necessitating a right VAD was 21% for TCS patients and non-TCS profile 1 patients compared with 2% for profile 2-3 patients (p < 0.001). Profile 1 and TCS patients had similar 1-year survival (70% and 77%, p = 0.57), but inferior survival as compared with profile 2 and 3 patients (82%, p < 0.001). On multivariable analysis, TCS increased the hazard of death twofold.
  
  
  CONCLUSIONS
  Temporary circulatory support restores hemodynamics and reverses end-organ dysfunction. Nevertheless, these patients have high residual risk with postoperative morbidity and mortality that parallels profile 1 patients without TCS. Caution is suggested in downgrading risk for TCS patients with improved hemodynamic stability.
authors: Inova Heart and Vascular Institute, Falls Church, Virginia. Electronic address: palak.shah@inova.org.
authors: Palak
authors: P
authors: Shah
authors: University of Michigan, Ann Arbor, Michigan.
authors: Francis D
authors: FD
authors: Pagani
authors: Inova Heart and Vascular Institute, Falls Church, Virginia.
authors: Shashank S
authors: SS
authors: Desai
authors: Inova Heart and Vascular Institute, Falls Church, Virginia.
authors: Anthony J
authors: AJ
authors: Rongione
authors: Vanderbilt University, Nashville, Tennessee.
authors: Simon
authors: S
authors: Maltais
authors: Vanderbilt University, Nashville, Tennessee.
authors: Nicholas A
authors: NA
authors: Haglund
authors: Mayo Clinic College of Medicine, Rochester, Minnesota.
authors: Shannon M
authors: SM
authors: Dunlay
authors: University of Michigan, Ann Arbor, Michigan.
authors: Keith D
authors: KD
authors: Aaronson
authors: Mayo Clinic College of Medicine, Rochester, Minnesota.
authors: John M
authors: JM
authors: Stulak
authors: Vanderbilt University, Nashville, Tennessee.
authors: Mary Beth
authors: MB
authors: Davis
authors: St. Vincent Heart Center of Indiana, Indianapolis, Indiana.
authors: Christopher T
authors: CT
authors: Salerno
authors: St. Vincent Heart Center of Indiana, Indianapolis, Indiana.
authors: Jennifer A
authors: JA
authors: Cowger
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology