Details

Autor(en) / Beteiligte

• Shah, Palak, MD, MS
• Pagani, Francis D., MD, PhD
• Desai, Shashank S., MD
• Rongione, Anthony J., MD
• Maltais, Simon, MD, PhD
• Haglund, Nicholas A., MD
• Dunlay, Shannon M., MD, MS
• Aaronson, Keith D., MD, MS
• Stulak, John M., MD, PhD
• Davis, Mary Beth, MS
• Salerno, Christopher T., MD
• Cowger, Jennifer A., MD, MS

Titel

Outcomes of Patients Receiving Temporary Circulatory Support Before Durable Ventricular Assist Device

Ist Teil von

• The Annals of thoracic surgery, 2017-01, Vol.103 (1), p.106-112

Ort / Verlag

Netherlands: Elsevier Inc

Erscheinungsjahr

2017

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Temporary circulatory support (TCS) is used to stabilize patients in critical cardiogenic shock and bridge patients to a durable ventricular assist device (VAD). Whether TCS confers increased risk at the time of VAD implant is unknown. Methods Prospectively collected data from five institutions was retrospectively reviewed. All profile 1 through profile 3 patients implanted with a continuous-flow VAD (n = 804) were categorized into three groups: TCS (n = 68); non-TCS profile 1 (n = 70); and non-TCS profile 2-3 (n = 666). Results End-organ function and hemodynamics were worse before TCS than in non-TCS profile 1 patients: creatinine (1.7 ± 0.1 mg/dL versus 1.3 ± 0.06 mg/dL, p  = 0.003); and right atrial pressure (16 ± 0.8 mm Hg versus 13 ± 1.1 mm Hg, p  = 0.048). The TCS restored cardiac output before durable VAD (4.9 ± 0.2 L/min), and was comparable to profile 2-3 patients (4.3 ± 0.05 L/min) and better than profile 1 patients (4.0 ± 0.2 L/min, p  = 0.002). Markers of hepatic function such as bilirubin were impaired before VAD in TCS and profile 1 patients (2.0 ± 0.2 mg/dL) compared with profile 2 and 3 patients (1.1 ± 0.03, p < 0.001). The incidence of postoperative right ventricular failure necessitating a right VAD was 21% for TCS patients and non-TCS profile 1 patients compared with 2% for profile 2-3 patients ( p < 0.001). Profile 1 and TCS patients had similar 1-year survival (70% and 77%, p  = 0.57), but inferior survival as compared with profile 2 and 3 patients (82%, p < 0.001). On multivariable analysis, TCS increased the hazard of death twofold. Conclusions Temporary circulatory support restores hemodynamics and reverses end-organ dysfunction. Nevertheless, these patients have high residual risk with postoperative morbidity and mortality that parallels profile 1 patients without TCS. Caution is suggested in downgrading risk for TCS patients with improved hemodynamic stability.