Bridging to a Long-Term Ventricular Assist Device With Short-Term Mechanical Circulatory Support

Chitaru Kurihara, Masashi Kawabori, Tadahisa Sugiura, Andre C. Critsinelis, Suwei Wang, William E. Cohn, Andrew B. Civitello, O. H. Frazier, Jeffrey A. Morgan

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Implanting short-term mechanical circulatory support (MCS) devices as a bridge-to-decision is increasingly popular. However, outcomes have not been well studied in patients who receive short-term MCS before receiving long-term left ventricular assist device (LVAD) support. We analyzed outcomes in our single-center experience with long-term continuous-flow (CF)-LVAD recipients with pre-implantation short-term MCS. From November 2003 through March 2016, 526 patients (mean age, 54.7 ± 13.5 years) with chronic heart failure (mean ejection fraction, 21.7 ± 3.6%) underwent implantation of either the HeartMate II (n = 403) or the HeartWare device (n = 123). Before implantation, 269 patients received short-term MCS with the TandemHeart, the Impella 2.5/5.0, an intra-aortic balloon pump (IABP), venoarterial extracorporeal membrane oxygenation (VA-ECMO), or the CentriMag. The short-term MCS patients were compared with the CF-LVAD–only patients regarding preoperative demographics, incidence of postoperative complications, and long-term survival. The 269 patients received the following short-term MCS devices: 57 TandemHeart, 27 Impella, 172 IABP, 12 VA-ECMO, and 1 CentriMag. Survival at 30 days, 6 months, 1 year, and 2 years was 94.2, 87.2, 79.4, and 72.4%, respectively, for CF-LVAD–only patients versus 91.0, 78.1, 73.4, and 65.6%, respectively, for short-term MCS + CF-LVAD patients (P = 0.17). Within the short-term MCS group, survival at 24 months was poorest for patients supported with VA-ECMO or the TandemHeart (P = 0.03 for both), and survival across all four time points was poorest for patients supported with VA-ECMO (P = 0.02). Short-term MCS was not an independent predictor of mortality in multivariate Cox regression models (hazard ratio = 1.12, 95% confidence interval = 0.84–1.49, P = 0.43). In conclusion, we found that using short-term MCS therapy—except for VA-ECMO—as a bridge to long-term CF-LVAD support was not associated with poorer survival.

Original languageEnglish (US)
Pages (from-to)589-596
Number of pages8
JournalArtificial Organs
Volume42
Issue number6
DOIs
StatePublished - Jun 2018
Externally publishedYes

Fingerprint

Left ventricular assist devices
Heart-Assist Devices
Oxygenation
Membranes
Balloons
Extracorporeal Membrane Oxygenation
Pumps
Survival
Hazards
Equipment and Supplies
Self-Help Groups
Proportional Hazards Models
Heart Failure
Demography

Keywords

  • Left ventricular assist device
  • —Long-term
  • —Mechanical circulatory support
  • —Outcomes
  • —Short-term

ASJC Scopus subject areas

  • Bioengineering
  • Medicine (miscellaneous)
  • Biomaterials
  • Biomedical Engineering

Cite this

Kurihara, C., Kawabori, M., Sugiura, T., Critsinelis, A. C., Wang, S., Cohn, W. E., ... Morgan, J. A. (2018). Bridging to a Long-Term Ventricular Assist Device With Short-Term Mechanical Circulatory Support. Artificial Organs, 42(6), 589-596. https://doi.org/10.1111/aor.13112

Bridging to a Long-Term Ventricular Assist Device With Short-Term Mechanical Circulatory Support. / Kurihara, Chitaru; Kawabori, Masashi; Sugiura, Tadahisa; Critsinelis, Andre C.; Wang, Suwei; Cohn, William E.; Civitello, Andrew B.; Frazier, O. H.; Morgan, Jeffrey A.

In: Artificial Organs, Vol. 42, No. 6, 06.2018, p. 589-596.

Research output: Contribution to journalArticle

Kurihara, C, Kawabori, M, Sugiura, T, Critsinelis, AC, Wang, S, Cohn, WE, Civitello, AB, Frazier, OH & Morgan, JA 2018, 'Bridging to a Long-Term Ventricular Assist Device With Short-Term Mechanical Circulatory Support', Artificial Organs, vol. 42, no. 6, pp. 589-596. https://doi.org/10.1111/aor.13112
Kurihara, Chitaru ; Kawabori, Masashi ; Sugiura, Tadahisa ; Critsinelis, Andre C. ; Wang, Suwei ; Cohn, William E. ; Civitello, Andrew B. ; Frazier, O. H. ; Morgan, Jeffrey A. / Bridging to a Long-Term Ventricular Assist Device With Short-Term Mechanical Circulatory Support. In: Artificial Organs. 2018 ; Vol. 42, No. 6. pp. 589-596.
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abstract = "Implanting short-term mechanical circulatory support (MCS) devices as a bridge-to-decision is increasingly popular. However, outcomes have not been well studied in patients who receive short-term MCS before receiving long-term left ventricular assist device (LVAD) support. We analyzed outcomes in our single-center experience with long-term continuous-flow (CF)-LVAD recipients with pre-implantation short-term MCS. From November 2003 through March 2016, 526 patients (mean age, 54.7 ± 13.5 years) with chronic heart failure (mean ejection fraction, 21.7 ± 3.6{\%}) underwent implantation of either the HeartMate II (n = 403) or the HeartWare device (n = 123). Before implantation, 269 patients received short-term MCS with the TandemHeart, the Impella 2.5/5.0, an intra-aortic balloon pump (IABP), venoarterial extracorporeal membrane oxygenation (VA-ECMO), or the CentriMag. The short-term MCS patients were compared with the CF-LVAD–only patients regarding preoperative demographics, incidence of postoperative complications, and long-term survival. The 269 patients received the following short-term MCS devices: 57 TandemHeart, 27 Impella, 172 IABP, 12 VA-ECMO, and 1 CentriMag. Survival at 30 days, 6 months, 1 year, and 2 years was 94.2, 87.2, 79.4, and 72.4{\%}, respectively, for CF-LVAD–only patients versus 91.0, 78.1, 73.4, and 65.6{\%}, respectively, for short-term MCS + CF-LVAD patients (P = 0.17). Within the short-term MCS group, survival at 24 months was poorest for patients supported with VA-ECMO or the TandemHeart (P = 0.03 for both), and survival across all four time points was poorest for patients supported with VA-ECMO (P = 0.02). Short-term MCS was not an independent predictor of mortality in multivariate Cox regression models (hazard ratio = 1.12, 95{\%} confidence interval = 0.84–1.49, P = 0.43). In conclusion, we found that using short-term MCS therapy—except for VA-ECMO—as a bridge to long-term CF-LVAD support was not associated with poorer survival.",
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