Longitudinal Impact of Temporary Mechanical Circulatory Support on Durable Left Ventricular Assist Device Outcomes: An IMACS Registry Analysis.
Hernandez-Montfort JA, Ton VK, Xie R, Fisher A, Meyns B, Nakatani T, Netuka I, Pettit S, Shaw S, Yanase M, Kirklin JK, Rowe A, Goldstein DJ, and Cowger J. Longitudinal Impact of Temporary Mechanical Circulatory Support on Durable Left Ventricular Assist Device Outcomes: An IMACS Registry Analysis. J Heart Lung Transplant 2019; 38(4 Suppl ):S33.
J Heart Lung Transplant
Purpose: To characterize longitudinal outcomes of durable LVAD patients presenting with preoperative cardiogenic shock according to temporary circulatory support (TCS) management strategy. Methods: Patients (n=13813) enrolled into IMACS (2013-2017) supported with continuous flow LVADs were analyzed. Patients were grouped according to use of TCS vs. no TCS by Profile. TCS patients were subgrouped according to support type (ECMO, IABP, other-TCS) and morbidity and mortality were analyzed. Results: TCS was used in 5631 (42%) patients in IMACS. Of these, ECMO was used in 1138 (20%), IABP in 3901 (69%), and other-TCS in 595 (11%). More patients on ECMO had ischemic cardiomyopathy (52% ECMO, 44% IABP, 42% Other-TCS, 40% no-TCS, p < 0.001) and were less like to be bridge-to-transplant with higher preop bilirubin and lower albumin than IABP, other-TCS, and noTCS. Fewer IABP patients were categorized as profile I (78% ECMO, 30% IABP, 45% Other TCS, p < 0.001). Perioperatively, ECMO patients required BiVAD more frequently (22% ECMO, 5% IABP, 7% Other-TCS, 3% no-TCS, p< 0.001) and experienced longer ICU LOS/days (24 d ECMO, 14 d IABP, 18 d Other-TCS, 11d no-TCS, p <0.001). ECMO supported patients had the lowest short- and long-term survivals, while IABP vs other-TCS vs noTCS has similar survivals (table). ECMO conferred inferior survival in BiVAD patients as well (48 mo: 45% ECMO, 51% IABP, 53% Other-TCS, 56% no-TCS, p < 0.001). Conclusion: In cardiogenic shock patients, the use of ECMO prior to LVAD was associated with lower survival, longer ICU stay and more RV failure compared to other TCS. ECMO patients with persistent RV failure have the worst prognosis.