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

JTCVS open Pub Date : 2024-10-01 DOI:10.1016/j.xjon.2024.06.021

Daniel Lewin , Sebastian V. Rojas MD , Michael Billion MD , Anna L. Meyer MD , Ivan Netuka MD , Janajade Kooij MD , Marina Pieri MD , Antonio Loforte MD , Mariusz K. Szymanski MD , Christian H. Moeller MD , Payam Akhyari MD , Khalil Jawad MD , Ihor Krasivskyi MD , Bastian Schmack MD , Gloria Färber MD , Marta Medina MD , Assad Haneya MD , Daniel Zimpfer MD , Gaik Nersesian MD , Mehmet Oezkur MD , Evgenij V. Potapov MD

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引用次数: 0

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.

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使用或不使用体外生命支持微轴流泵进行临时循环支持后的耐用左心室辅助装置

背景使用导管式微轴流泵（mAFP）进行循环支持在治疗严重心源性休克中发挥着重要作用。对于大多数在接受临时机械循环支持（tMCS）后仍无法康复且不符合心脏移植条件的患者，植入耐用左室辅助装置（dLVAD）通常被认为是一种可靠的选择。这项研究旨在描述在接受 mAFP 支持后进行 dLVAD 治疗的结果，并确定死亡率的预测因素。方法这是一项多中心登记数据的回顾性分析，研究对象是在 2017 年 1 月至 2022 年 10 月期间接受 tMCS 后植入 dLVAD 并使用 mAFP 的患者（n = 332），这些患者来自 19 个欧洲中心。结果患者使用 Impella 5.5（n = 92）、5.0（n = 153）或 CP（n = 87），并在同一时期过渡到 HeartWare HVAD（n = 128）或 Heartmate 3（n = 204）。125 名患者（39.2%）在接受 mAFP 治疗之前和/或期间还需要体外生命支持。30 天和 1 年存活率分别为 87.8% 和 71.1%。1年死亡率的风险因素如下：年龄（比值比 [OR]，1.02），特别是 55 岁以上（OR，1.09），体重指数>30 kg/m2（OR，2.2），女性性别（男性性别的比值比为 0.结论根据已确定的风险因素，计算出估算 1 年死亡率的风险评分，以优化 dLVAD 植入患者的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JTCVS open

CiteScore

1.70

自引率

0.00%

发文量