Use of Intravascular Micro-Axial Left Ventricular Assist Devices as a Bridging Strategy for Cardiogenic Shock: Mid-Term Outcomes

• Published in: Journal of clinical medicine 2024-11, Vol.13 (22), p.6804
• Main Authors: Mahesh, Balakrishnan, Peddaayyavarla, Prasanth, Nguyen, Kenny, Mahesh, Aditya, Hartford, Corrine Corrina, Devich, Robert, Dafflisio, Gianna, Nair, Nandini, Freundt, Miriam, Dowling, Robert, Soleimani, Behzad
• Format: Article
• Language: English
• Subjects: Body mass index; Cardiogenic shock; Care and treatment; Catheters; Heart failure; Ischemia; Mortality; Patient outcomes; Patients; Regression analysis; Statistical significance; Transplants & implants; Variables; Veins & arteries
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm13226804

: Patients in cardiogenic shock (CS) may be successfully bridged using intravascular micro-axial left ventricular assist devices (M-LVADs) for recovery or determination of definitive therapy. : One hundred and seven CS patients implanted with M-LVADs from January 2020 to May 2024 were divided into four groups; group-1: 34 patients (transplant); group-2: 25 patients (LVAD); group-3: 42 patients (postcardiotomy CS (PCCS)); group-4: 6 patients (decision/recovery but excluded from analysis). Multivariable logistic regression and Multivariable Coxregression models identified predictors of early -hospital and late mortality, and Odds ratios (ORs) and hazard ratios (HRs) with < 0.05, respectively, were considered statistically significant. SPSS 29.0 and Python 3.11.1. were used for analyses. : Complications included device-malfunction (6%), gastrointestinal bleed (9%), long-term hemodialysis (21%), axillary hematoma requiring re-exploration (10%), heparin-induced thrombocytopenia (4%) requiring heparin therapy cessation/initiation of argatroban infusion, and non-fatal stroke (11%). Early hospital mortality included 13 patients: 2 in group-1, 1 in group-2, 10 in group-3 ( = 0.02). In the Logistic-Regression model, category of CS requiring an M-LVAD was significant (OR = 4.7, = 0.05). Patients were followed for 4.5 years (mean follow-up was 23 ± 17 months), and 23 deaths occurred; group-1: 3 patients, group-2: 5 patients, and group-3: 15 patients ( = 0.019). At 4.5 years, actuarial survival was 90.7 ± 5.1% in group-1, 79.2 ± 8.3% in group-2, 62.8 ± 7.7% in group-3 ( = 0.01). In the Cox-Regression model, M-LVAD category (HR = 3.63, = 0.04), and long-term postoperative dialysis (HR = 3.9, = 0.002) emerged as predictors of long-term mortality. : In cardiogenic shock, mid-term outcomes demonstrate good survival with M-LVADs as bridge to transplant/durable LVADs and reasonable survival with M-LVADs as a bridge to recovery following cardiotomy, accompanied by reduced ECMO usage, and early ambulation/rehabilitation.