Short and Long-Term Adverse Events in Patients on Temporary Circulatory Support before LVAD: An IMACS Registry Analysis.
Ton V, Hernandez-Montfort JA, Xie R, Meyns BP, Nakatani T, Yanase M, Shaw S, Pettit S, Netuka I, Kirklin J, Goldstein DJ, and Cowger J. Short and Long-Term Adverse Events in Patients on Temporary Circulatory Support before LVAD: An IMACS Registry Analysis. J Heart Lung Transplant 2019; 38(4 Suppl):S32-S33.
J Heart Lung Transplant
Purpose: Patients with cardiogenic shock (CS) needing temporary circulatory support (TCS) have poor survival after LVAD. We aim to characterize complication burden in those requiring preop TCS. Methods: We analyzed 13,511 adults with CF-LVADs in IMACS (2013-2017) according to need for preop TCS (n=5632) vs. no TCS (n=7879, Profiles 1-3). Rates of bleeding, device-related infection and stroke in early (< 3 months) and late (> 3 months) postop periods in those with and without TCS were compared. Results: TCS included ECMO (n=1138), IABP (n=3901), and other-TCS (n=593). Compared with nonTCS Profile 1-3 patients, TCS patients were more likely to have ischemic cardiomyopathy, Profile 1 status (TCS=41% vs 5.3%), with lower albumin preop. Within 3 months postop, patients previously on ECMO or IABP had more major bleeding, hemorrhagic and ischemic strokes, and gastrointestinal bleeding (GIB) than nonTCS patients, while patients on other-TCS had more early device-related infections (Figure, A). After 3 months postop, while clinically of small difference, those on ECMO or other-TCS had statistically lower rates of major bleeding and GIB compared to non-TCS, while IABP group had higher bleeding rates (Figure, B). All groups had low and similar late ischemic stroke rates (Figure, B). Short- and long-term survivals were worst in ECMO compared with other groups (6 mo: 71% ECMO, 84% IABP, 84% other-TCS, 88% non-TCS. 48 mo: 45% ECMO, 51% IABP, 53% other-TCS, 56% non-TCS, p<0.0001). Strokes and multi-organ failure were 2 most common causes of death. Conclusion: Patients requiring TCS prior to durable LVADs had higher rates of early postop adverse events compared to those without TCS. Late event rates were similar. ECMO is associated with very high early ischemic stroke, bleeding burdens and mortality. Multi-organ failure and stroke are the most common causes of death in TCS patients. These results suggest that the extreme CS phenotype needing ECMO warrants a higher-level Profile status, such as “INTERMACS 0”.