JTCVS Open (Oct 2024)
Durable left ventricular assist devices following temporary circulatory support on a microaxial flow pump with and without extracorporeal life supportCentral MessagePerspective
- 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,
- Ilija Djordjevic, MD,
- Diyar Saeed, MD,
- Julia Stein,
- Adriaan O. Kraaijeveld, MD,
- Finn Gustafsson, MD,
- Mara Scandroglio, MD,
- Bart Meyns, MD,
- Steffen Hofmann, MD,
- Jan Belohlavek, MD,
- Jan F. Gummert, MD,
- Pia Lanmueller, MD,
- Alexander M. Bernhardt, MD,
- Evgenij V. Potapov, MD
Affiliations
- Daniel Lewin
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany; Department of Cardiovascular Surgery, Charité– Universitätsmedizin Berlin, Berlin, Germany; Address for reprints: Daniel Lewin, Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Augustenburger Platz 1, Berlin 13353, Germany.
- Sebastian V. Rojas, MD
- Heart and Diabetes Center, Bad Oeynhausen, North Rhine-Westphalia, Germany
- Michael Billion, MD
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
- Anna L. Meyer, MD
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Ivan Netuka, MD
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic; Second Department of Internal Medicine, Cardiovascular Medicine, General Teaching Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
- Janajade Kooij, MD
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
- Marina Pieri, MD
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Antonio Loforte, MD
- Department of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola University Hospital, Bologna, Italy; Department of Surgical Sciences, University of Turin, Turin, Italy
- Mariusz K. Szymanski, MD
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Christian H. Moeller, MD
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
- Payam Akhyari, MD
- Department of Cardiovascular Surgery, University Hospital Duesseldorf, Duesseldorf, Germany; Department of Cardiothoracic Surgery, University Hospital RTWH Aachen, Aachen, Germany
- Khalil Jawad, MD
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
- Ihor Krasivskyi, MD
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
- Bastian Schmack, MD
- Department of Cardiac Surgery, University of Essen, Essen, Germany
- Gloria Färber, MD
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
- Marta Medina, MD
- Department of Cardiac and Vascular Surgery, University of Mainz, Mainz, Germany
- Assad Haneya, MD
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
- Daniel Zimpfer, MD
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
- Gaik Nersesian, MD
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany; Department of Cardiovascular Surgery, Charité– Universitätsmedizin Berlin, Berlin, Germany; German Center for Cardiovascular Research, Berlin, Germany
- Mehmet Oezkur, MD
- Department of Cardiac and Vascular Surgery, University of Mainz, Mainz, Germany
- Ilija Djordjevic, MD
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
- Diyar Saeed, MD
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
- Julia Stein
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
- Adriaan O. Kraaijeveld, MD
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Finn Gustafsson, MD
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
- Mara Scandroglio, MD
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Bart Meyns, MD
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
- Steffen Hofmann, MD
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
- Jan Belohlavek, MD
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic; Second Department of Internal Medicine, Cardiovascular Medicine, General Teaching Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
- Jan F. Gummert, MD
- Heart and Diabetes Center, Bad Oeynhausen, North Rhine-Westphalia, Germany
- Pia Lanmueller, MD
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany; Department of Cardiovascular Surgery, Charité– Universitätsmedizin Berlin, Berlin, Germany; German Center for Cardiovascular Research, Berlin, Germany
- Alexander M. Bernhardt, MD
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
- Evgenij V. Potapov, MD
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany; Department of Cardiovascular Surgery, Charité– Universitätsmedizin Berlin, Berlin, Germany; German Center for Cardiovascular Research, Berlin, Germany
- Journal volume & issue
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Vol. 21
pp. 168 – 179
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.
