TCT-340 Incidence and Impact of Vascular Complications When Utilizing Mechanical Circulatory Support
Lemor A, Dabbagh M, Villablanca P, Alaswad K, O'Neill W, and Basir M. TCT-340 Incidence and Impact of Vascular Complications When Utilizing Mechanical Circulatory Support. J Am Coll Cardiol 2021; 78(19):B139.
J Am Coll Cardiol
Background: The use of mechanical circulatory support (MCS) has increased in the past decade with aims to increase survival in patients in shock and to support high-risk procedures. The impact of vascular complications when using MCS is not well studied.
Methods: Using the National Inpatient Sample from 2015 to 2018, we identified hospital admissions in which an intra-aortic balloon pump (IABP), Impella (Abiomed), and/or extracorporeal membrane oxygenation (ECMO) were used for any condition. The study outcomes included in-hospital mortality, rates of vascular complications, and any procedures required to treat the complication (ie, angioplasty, open vessel repair, fasciotomy, and/or limb amputation).
Results: A total of 204,255 hospitalizations requiring MCS were identified. IABP was the most common MCS used (63.4%) followed by Impella (19.4%) and ECMO (12.0%); 5.2% of hospitalizations used > 1 MCS. The rates of vascular complications with IABP were 3.0%, with Impella they were 6.5%, and with ECMO they were 13.5% (Figure 1). In patients requiring > 1 MCS, there was a 17.1% rate of vascular complication. Predictors of vascular complication include female sex, systolic heart failure, peripheral arterial disease, and use of vasopressors. Total hospital costs were significantly higher in patients with vascular complications compared with those without ($116,094 vs $55,261, P < 0.001).
Conclusion: Vascular complications are associated with higher odds of in-hospital mortality and higher resource utilization in patients treated with MCS. Predictors of vascular complications include larger arteriotomy size, female gender, systolic heart failure, peripheral arterial disease, and use of vasopressors.