P66: Incidence of DVT formation in patients requiring temporary mechanical circulatory support for cardiogenic shock

Abstract

Background: After the 2018 UNOS organ allocation change, temporary mechanical circulatory support (tMCS) has increased in managing acute decompensated heart failure (ADHF) as a bridge to transplant, recovery, or durable VAD. However, patients supported with tMCS are more prone to complications. Deep venous thrombosis (DVT) is one of the most common complications in this patient population. DVT is associated with an increased risk of pulmonary embolism, stroke, chronic venous insufficiency, and increased length of hospital stays. We aimed to identify the incidence of DVT in ADHF patients supported with tMCS. Method: We performed a retrospective review of patients with ADHF who had undergone heart or heart/kidney transplantation between January 2021 and November 2022 at Mayo Clinic in Florida. Patient data were extracted from the electronic health record after IRB approval as exempt for retrospective chart review was obtained. Our primary outcome was DVT during the transplant, diagnosed by venous duplex ultrasonography. Results: 93 patients with ADHF were found during our review period, of which 46 (49%) developed a DVT. The median age was 60 years (53 – 67), with 65% male. All but one DVT was in the upper extremity. Within the DVT population, 75% were hypertensive (p <.001), 64% were diabetic (p =.003), 78% had hyperlipidemia (p<.001), and had elevated mean creatinine of 2.16 vs. 1.55 (p =.04). A total of 44 patients required tMCS, of these, 26 patients developed DVT (59%) which was statistically significant compared to 18 that did not develop DVT while on tMCS, p =.04. The combination of support was as follows: 27 axillary Impella 5.5 alone, 5 VA ECMO without LV vent, 1 VA ECMO with IABP vent, 4 VA ECMO with Impella 5.5 vent, and 7 intra-aortic balloon pumps only. Ischemic cardiomyopathy was not a significant risk for DVT, p =.372. The median ejection fraction was 25% (15 -55). The median LOS was 48 days (31 – 74). Patients with DVT were found to have a significantly lower BMI, 26.4 vs 29.3 (p =.002), as well as a significantly shorter cardiopulmonary bypass time of 187min vs. 296 min (p <.001). Conclusions: We found increased rates of DVT in patients utilizing all forms of tMCS with ADHF. Factors influencing the development of DVT may relate to an overall increased inflammatory state, evidenced by our data showing significant differences in rates of hypertension, diabetes, hyperlipidemia, worse renal function, and sarcopenia. Chronicity of disease, time in the hospital, and the need for more procedures may also influence DVT risk in patients awaiting transplantation or LVAD.