Midterm Outcomes of Bridge-to-Recovery Patients After Short-Term Mechanical Circulatory Support

Abstract

The use of short-term mechanical circulatory support (ST-MCS) has increased for refractory cardiogenic shock. However, there are scant data about bridge-to-recovery patients. We retrospectively reviewed 502 patients with cardiogenic shock who received venoarterial extracorporeal membrane oxygenation or a temporary surgical ventricular assist device as ST-MCS between 2010 and 2016. There were 178 patients (35.5%) who survived through device explantation. Of these, 149 patients (29.7%) survived to discharge and were included for analysis. The primary outcome was midterm survival without undergoing heart replacement therapy. In our bridge-to-recovery cohort, 101 patients (67.8%) were men, and the median age was 59 years (interquartile range, 51 to 67 years). Etiology of cardiogenic shock included postcardiotomy shock in 35.6% of patients (n= 53), allograft failure in 26.8% (n= 40), acute myocardial infarction (AMI) in 24.2% (n= 36), and other acute decompensated heart failure in 14.4% (n= 20). There were 24 major events (16.1%) recorded, including 21 patients who died and 3 patients who received heart replacement therapy during median follow-up of 306 days (interquartile range, 58.25 to 916.75 days). Overall freedom from event at 3 years was 74.2%. In subgroup analysis, AMI patients had a significantly worse freedom-from-event rate at 40.4% (p < 0.001). By univariate Cox analysis, AMI etiology (p= 0.003), length of ST-MCS (p= 0.06), blood urea nitrogen (p= 0.012), and left ventricular ejection fraction (p= 0.005) at discharge were predictors for adverse events. The overall midterm outcome of patients explanted from ST-MCS is favorable except for AMI patients.