Outcomes of Patients Bridged with Acute Mechanical Circulatory Support Devices to HeartMate 3

Justin Fried ,N Sumzin,J Raikhelkar ,M Yuzefpolskaya ,Yuji Kaku ,Yoshifumi Naka ,J Sanchez ,P.c Colombo ,V.k Topkara ,Z Roth ,D Marshall ,Nir Uriel ,Gabriel Sayer ,Amirali Masoumi ,Dimitri Karmpaliotis ,Ajay J Kirtane ,Jan M Griffin ,Lucas Witer ,Hiroo Takayama ,Kevin J Clerkin ,Koji Takeda

doi:10.1016/j.healun.2020.01.776

Justin Fried , N Sumzin + Show 19 more

https://doi.org/10.1016/j.healun.2020.01.776

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Acute mechanical circulatory support devices (MCSD) are increasingly being used to stabilize and optimize patients for durable left ventricular assist device (LVAD) implantation. The primary objective of our study was to assess the outcomes of patients bridged with acute MCSD to HeartMate 3 (HM3). We retrospectively reviewed 165 consecutive patients implanted with a HM3 at our institution from November 2014 to July 2019. Baseline clinical characteristics, hemodynamic data, and post-operative outcomes were assessed. Patients bridged with intraaortic balloon pumps (IABP), extracorporeal membrane oxygenation (ECMO) and/or Impella percutaneous ventricular assist device (pVAD) were compared to patients that were directly implanted with HM3. Of the 165 patients, 69 (41.8%) were bridged to HM 3 LVAD with acute MCSD during the study period. The following device configurations were used: 3 patients with ECMO alone, 6 with ECMO + IABP, 2 ECMO + pVAD, 3 pVAD alone and 55 patients with IABP alone. Patients with acute MCSD were numerically younger (56.8 ±12.9 vs. 60.9 ±13.2, p =0.05) and had lower INTERMACS profile levels (1.71 ± 0.49 vs. 2.67 ± 0.64, p < 0.01). There was no difference in pre-operative cardiac index (1.88 ± 0.70 vs. 1.89 ± 0.46, p = 0.93); however, pre-device RA pressure (13.2 ± 6.5 vs. 8.3 ±5.2, p <0.01), pulmonary artery mean pressure (38.9 ±11.0 vs. 31.8 ± 8.7, p < 0.01) and pulmonary artery capillary wedge pressure (26.7 ± 9.3 vs. 20.5 ± 26.7, p < 0.01) were all higher in patients bridged with acute MCSD. There was no difference in survival at 1 year between patients bridged with acute MCSD and those who were not bridged (90.3% vs 89.5%, respectively, p=0.80, Figure 1). There was no difference in post-operative stroke or GI bleeding between the two groups. A large proportion of patients in the contemporary era are bridged with acute MCSD to HM3 and despite their increased severity of illness have outcomes comparable to patients who are not bridged with acute MCSD.

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