Abstract 14482: Clinical Impact of Advances of Short-Term Mechanical Circulatory Support Devices and Therapeutic Strategies in Patients With Cardiogenic Shock

Abstract

Introduction: Although revised US adult heart allocation system has provided the opportunity of urgent heart transplantation and improved clinical outcomes in urgent patients, it may not offer select temporary mechanical circulatory support (MCS) patients the opportunity and adequate time to recover to the point of waitlist removal. Severe donor shortages have increased the need for assessment of reversibility of cardiac function. Advances of MCS devices may provide the longer time to assess the appropriate therapeutic strategy. Hypothesis: The aim of this study was to evaluate the impact of bridge-to-decision (BTD) strategies which used recently developed short-term MCS devices strategies. Methods: We retrospectively reviewed the medical records of 108 patients who received BTD strategies from January 2017 to February 2022. Results: Etiology of cardiogenic shock were myocarditis (35.2 %), idiopathic cardiomyopathy (26.0 %) and ischemic cardiomyopathy (30.5 %). Ninety-three (86.1%) had been used any temporary MCS prior to BTD strategy using short-term MCS devices, including intra-aortic balloon pumping, peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) and low-flow percutaneous VAD. Sixty-five (60.2 %) had been inserted extracorporeal centrifugal-flow pump VAD (CF-VAD group), twenty-eight (25.9 %) had high-flow percutaneous VAD (P-VAD group) including with ECMO (ECPELLA) (50 %), and fifteen (13.9 %) had extracorporeal pulsatile-flow pump VAD (PF-VAD group). Duration of short-term MCS support was 42.5±44.1 days. Twenty-five (23.1 %) needed the conversion to other pumps. Forty-eight (40.7%) were withdrawn for recovery of cardiac function (mean duration to decision; 27.7±23.8 days), other forty-eight (40.7 %) were implanted durable implantable VAD for no-recovery of cardiac function (mean duration to decision; 48.4±40.7 days). Twenty patients (18.5 %) died. Clinical prognosis was comparable in three groups (P=0.943). Conclusions: BTD strategies using recently developed short-term MCS devices provided relatively long-term support duration to decision for definitive therapy, and showed favorable clinical outcomes. However, conversion or exchange to other pumps was needed for long-term support.