Short- and long-term adverse events in patients on temporary circulatory support before durable ventricular assist device: An IMACS registry analysis

Van Khue Ton, Rongbing Xie, Jaime A. Hernandez-Montfort, Bart Meyns, Takeshi Nakatani, Masanobu Yanase, Steve Shaw, Stephen Pettit, Ivan Netuka, James Kirklin, Daniel J. Goldstein, Jennifer Cowger

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Patients with cardiogenic shock (CS) needing temporary circulatory support (TCS) have poor survival rates after implantation of durable ventricular assist device (dVAD). We aimed to characterize post-dVAD adverse event burden and survival rates in patients requiring pre-operative TCS. METHOD: We analyzed 13,511 adults (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS] Profiles 1–3) with continuous-flow dVADs in International Society for Heart and Lung Transplantation Registry for Mechanically Assisted Circulatory Support (2013–2017) according to the need for pre-operative TCS (n = 5,632) vs no TCS (n = 7,879). Of these, 726 (5.4%) had biventricular assist devices (BiVAD). Furthermore, we compared prevalent rates (events/100 patient-months) of bleeding, device-related infection, hemorrhagic and ischemic cerebrovascular accidents (hemorrhagic cerebral vascular accident [hCVA], and ischemic cerebral vascular accident [iCVA]) in early (<3 months) and late (≥3 months) post-operative periods. RESULTS: TCS included extracorporeal membrane oxygenation (ECMO) (n = 1,138), intra-aortic balloon pump (IABP) (n = 3,901), and other TCS (n = 593). Within 3 post-operative months, there were more major bleeding and cerebrovascular accidents (CVAs) in patients with pre-operative ECMO (events/100 patient-months rates: bleeding = 19, hCVA = 1.6, iCVA = 2.8) or IABP (bleeding = 17.3, hCVA = 1.5, iCVA = 1.5) vs no TCS (bleeding = 13.2, hCVA = 1.1, iCVA = 1.2, all p < 0.05). After 3 months, adverse events were lower and similar in all groups. Patients with ECMO had the worst short- and long-term survival rates. Patients with BiVAD had the worst survival rate regardless of need for pre-operative TCS. CVA and multiorgan failures were the common causes of death for patients with TCS and patients without TCS. CONCLUSIONS: Patients requiring TCS before dVAD had a sicker phenotype and higher rates of early post-operative adverse events than patients without TCS. ECMO was associated with very high early ischemic stroke, bleeding, and mortality. The extreme CS phenotype needing ECMO warrants a higher-level profile status, such as INTERMACS “0.”

Original languageEnglish (US)
Pages (from-to)342-352
Number of pages11
JournalJournal of Heart and Lung Transplantation
Volume39
Issue number4
DOIs
StatePublished - Apr 2020

    Fingerprint

Keywords

  • adverse events
  • bleeding stroke
  • cardiogenic shock
  • extracorporeal membrane oxygenation
  • mortality
  • temporary mechanical circulatory support
  • ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Ton, V. K., Xie, R., Hernandez-Montfort, J. A., Meyns, B., Nakatani, T., Yanase, M., Shaw, S., Pettit, S., Netuka, I., Kirklin, J., Goldstein, D. J., & Cowger, J. (2020). Short- and long-term adverse events in patients on temporary circulatory support before durable ventricular assist device: An IMACS registry analysis. Journal of Heart and Lung Transplantation, 39(4), 342-352. https://doi.org/10.1016/j.healun.2019.12.011