Use Of Intra-aortic Balloon Pump Research Articles

Intra-Aortic Balloon Pump or Impella 5.0/5.5 as a Bridge to Heart Transplantation?

<h3>Purpose</h3> Impella 5.0/5.5 provide superior hemodynamic support and left ventricle unloading compared to intra-aortic balloon pump (IABP) but may be associated with more device-related complications. Limited comparative data exists on their use in patients with advanced heart failure awaiting transplantation. We evaluated patients bridged to transplant (BTT) with IABP versus Impella 5.0 or 5.5 <h3>Methods</h3> A prospective institutional registry identified 142 patients undergoing either IABP (n=77) or Impella 5.0/5.5 (n=65) implantation as BTT between 1/1/2017 and 12/31/2020. Analysis included only patients who were transplanted. Outcomes included 6-months survival, 6-months freedom from cardiac allograft vasculopathy (CAV: stenosis ≥30% by angiography), non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, pacemaker implant, stroke) and treated rejections <h3>Results</h3> The percentage of transplanted patients who were bridged with either Impella 5.0/5.5 or IABP increased from 19% (19/100) in 2017 to 28.6% (30/105) in 2020. Successful transplantation occurred in 75% (49/65) patients bridged with Impella and 68.9% (53/77) bridged with IABP (p=0.39). Among transplanted patients, several baseline characteristics differed between the Impella and IABP groups, including longer device duration, more pre-transplant packed red blood cell (PRBC) transfusions, and more multi-organ transplants in Impella patients (all p<0.05). At 6 months, post-transplant survival and stroke rates were similar (both p>0.5). In patients bridged with IABP, rates of rejections trended lower, while rates of CAV and NF-MACE were numerically higher, primarily driven by higher rates of pacemaker implant (Table) <h3>Conclusion</h3> The use of IABP and Impella 5.0/5.5 as BTT is increasing, with excellent 6-month survival. Registry analysis may help quantify the impact of increased blood product and induction therapy requirement associated with Impella 5.0/5.5 use

Is Temporary Here to Stay? Excellent Outcomes and Shorter Wait Times with Increased Use of Temporary Mechanical Support Since the 2018 Revision to Heart Transplant Allocation Policy

<h3>Purpose</h3> A 2018 revision to United States (US) heart transplant (HT) allocation policy grants higher priority to those treated with intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO), or other temporary mechanical support (tMCS). Use of each has since increased, likely to a varying extent across HT centers with a varying impact on outcomes. We assessed the impact at one high-volume center. <h3>Methods</h3> We included adult HT recipients in the year before ("pre"; n = 71) and after ("post"; n = 72) the allocation change on October 18, 2018. Recipient characteristics, clinical management, and outcomes were compared. <h3>Results</h3> Recipients after (vs. before) the allocation change were younger (mean age 52 vs. 55 years; p = 0.11) with higher rates of Hispanic ethnicity (21% vs. 7%; p = 0.017). More had non-ischemic dilated cardiomyopathy (67% vs. 45%; p = 0.009) and fewer had restrictive/infiltrative cardiomyopathy in the "post" (vs. pre) cohort (13% vs. 4%; p = 0.07). Pre-HT ECMO and IABP use increased from 0% of patients in the "pre" cohort to 11% and 32% in the "post" cohort, respectively (p < 0.005 for both changes). Concurrently, there was a trend towards lower durable ventricular assist device (VAD) use (27% to 19%; p = 0.30) and significantly lower median wait time (25 to 13 days; p = 0.049). One-year death or graft failure decreased (non-significantly) by almost half (pre: 8.5% post: 4.4%; p = 0.32) with no significant change in other post-HT outcomes. <h3>Conclusion</h3> The 2018 revision to US HT allocation policy prompted increased tMCS use at a high-volume center, to an even greater extent than seen nationwide. A concurrent drop in durable VAD use and waitlist time - with their attendant complications - could be offsetting the tMCS trend from a cost standpoint and driving a favorable trend in post-HT survival. The latter contrasts with nationwide trends, suggesting that the revised policy's impact could vary across institutions.

Long-Term Clinical Impact of Contrast-Associated Acute Kidney Injury Following PCI: AnADAPT-DES Substudy.

This study sought to determine correlates and consequences of contrast-associated acute kidney injury (CA-AKI) on clinical outcomes in patients with or without pre-existing chronic kidney disease (CKD). The incidence and impact of CA-AKI on clinical outcomes during contemporary percutaneous coronary intervention (PCI) are not fully defined. The ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents) study was a prospective, multicenter registry of 8,582 patients treated with≥1 drug-eluting stent(s). CA-AKI was defined as a post-PCI increase in serum creatinine of >0.5mg/dL or a relative increase of≥25% compared with pre-PCI. CKD was defined as estimated glomerular filtration rate<60mL/min/1.73m2. The primary endpoint was the 2-year rate of net adverse clinical events (NACE): All-cause mortality, myocardial infarction (MI), definite or probable stent thrombosis, or major bleeding. Of 7287 (85%) patients with evaluable data, 476 (6.5%) developed CA-AKI. In a multivariable model, older age, female sex, Caucasian race, congestive heart failure, diabetes, hypertension, CKD, presentation with ST-segment elevation MI, Killip class II to IV, radial access, intra-aortic balloon pump use, hypotension, and number of stents were independent predictors of CA-AKI. The 2-year NACE rate was higher in patients with CA-AKI (adjusted HR: 1.88; 95% CI: 1.42-2.49), as was each component of NACE (all-cause mortality, HR: 1.77; 95%CI: 1.22-2.55; MI, HR: 1.67; 95%CI: 1.18-2.36; definite/probable stent thrombosis, HR: 1.71; 95%CI: 1.10-2.65; and major bleeding, HR: 1.38; 95%CI: 1.06-1.80). Compared with the CA-AKI-/CKD- group, the CA-AKI+/CKD- (HR: 1.83; 95%CI: 1.33-2.52), CA-AKI-/CKD+ (HR: 1.56; 95%CI: 1.15-2.13), CA-AKI+/CKD+ (HR: 3.29; 95%CI: 1.92-5.67), and maintenance dialysis (HR: 2.67; 95%CI: 1.65-4.31) groups were at higher risk of NACE. CA-AKI was relatively common after contemporary PCI and was associated with increased 2-year rates of NACE. Patients with pre-existing CKD were at particularly high risk for NACE after CA-AKI.

Contemporary Single-Center Experience with Axillary Intra-Aortic Balloon Pumps

<h3>Purpose</h3> Intra-aortic balloon pumps (IABP) are increasingly being utilized to augment hemodynamic support in patients awaiting heart transplantation. In this subset of patients, the use of axillary IABP has the benefits of allowing increased mobility and decreased risk of infection when compared to the femoral approach for IABP. To further gain insight into the risks and benefits of this approach, we performed a retrospective review of our center's experience with axillary IABP. <h3>Methods</h3> We conducted a retrospective review of adult patients undergoing axillary IABP placement from July 2017 to April 2021. Variables collected included general patients' characteristics such as gender, age and comorbidities, indication for axillary IABP placement, hemodynamic parameters before and after IABP, days on axillary IABP, days from initial axillary IABP to transplant, postoperative and device complications. <h3>Results</h3> A total of 42 adults underwent open axillary IABP placement during the study period. Mean age was 52 years and most of the patients were male. The most common etiology was non-ischemic with an indication of bridge to transplantation (BTT) (<b>Table</b>). Successful orthotopic heart transplantation was performed in 40 of these patients. Mean duration of axillary IABP support was 19 days and mean duration from initial axillary IABP insertion to transplant was 27 days. Cardiac output and cardiac index significantly increased after IABP placement (p<0.001). Ten patients required one balloon exchange and two required two exchanges. Device malfunction was the most common IABP complication and acute kidney injury was the most common patient complication. There were no mortalities related to IABP placement. <h3>Conclusion</h3> Axillary intra-aortic balloon pump use has risen over the past years. The most common indication for axillary IABP at our institution was BTT with a success rate of 97.5%. The most common balloon complication was malfunction requiring an exchange, and the most common patient complication was acute kidney injury.

Derivation and Accuracy of “Pocket-Sized” Criteria for Primary Graft Dysfunction After Heart Transplant

<h3>Purpose</h3> ISHLT criteria for primary graft dysfunction (PGD) after heart transplant (HT) require data often absent in large databases - a major barrier for research. We derived and evaluated a simpler set of PGD criteria. <h3>Methods</h3> In a single-center cohort of 197 adult HTs, we classified PGD on chart review using ISHLT criteria as a "gold-standard". Then, from the ISHLT criteria, we removed systemic arterial pressure and assumed the absence of high pulmonary vascular resistance. For isolated right ventricular PGD, we assumed the use of inotrope(s) (but not intra-aortic balloon pump (IABP)) and altered the pulmonary capillary wedge pressure "cutoff". After these changes, the ISHLT definition is equivalent to the following, wherein any one of the three criteria implies PGD: (1) left ventricular ejection fraction ≤ 40% (2) right atrial pressure > 15 mmHg, cardiac index < 2 L/min², and use of either inotrope(s) or IABP (3) any mechanical support (other than IABP). We applied these "pocket-sized" criteria to classify PGD in our cohort, using only an institutional registry for which data collection is largely automated, and evaluated their diagnostic performance relative to the "gold standard". <h3>Results</h3> PGD prevalence was 23% by pocket-sized criteria and 21% by ISHLT criteria. There was discordance between the two in 8.1% of cases; these discordant cases ranged from absent to moderate per ISHLT criteria. Sensitivity, specificity, and positive and negative predictive value of the pocket-sized criteria were 86%, 94%, 78%, and 96%. <h3>Conclusion</h3> "Pocket-sized" PGD criteria may be sufficient for research applications but require further validation.

Can we have a rationalized selection of intra-aortic balloon pump, Impella, and extracorporeal membrane oxygenation in the catheterization laboratory?

Cardiac assistance represents an emerging issue in cardiovascular medicine. The evolution of invasive cardiology techniques is making the catheterization laboratory one of the main hospital sites where implantation of percutaneous ventricular assistance devices (PVADs) is discussed and performed. Among available PVADs, intra-aortic balloon pump (IABP), Impella, and extracorporeal membrane oxygenation (ECMO) are the most popular and offer completely different levels and ways to assist critical patients. The main settings calling for PVAD consideration in the catheterization laboratory are clinically indicated high-risk patients (CHIP) undergoing percutaneous coronary intervention (PCI) and patients with cardiogenic shock or refractory cardiac arrest.In CHIP, PVAD serves the purpose of preventing hemodynamic collapse during PCI. This may also allow more extensive revascularizations and higher quality revascularization plans (imaging use, debulking, stent result optimization). IABP or Impella are more commonly selected whereas ECMO is seldom considered as a third option for highly selected patients. The “elective” nature of CHIP-PCI should allow careful procedure planning (peripheral artery disease assessment, access site selection and management) in order to minimize vascular/bleeding complications.Cardiogenic shock is still associated with high mortality rates, and PVAD theoretically offers further recovery chances. The lack of benefit observed with systematic IABP use is currently prompting consideration of the roles of Impella and ECMO. Prolonged assistance is often needed. Thus, team decisions and shared protocols for PVAD selection have to be promoted, taking into consideration available resources and operators’ skills.In this paper, we critically review the available data in the field and highlight the possible decision-making hubs that catheterization-laboratory teams may consider in order to rationalize PVAD selection.

CRT-100.13 The Combined Use of Intra-Aortic Balloon Pump and Impella in Cardiogenic Shock Patients: More Is Better?

CRT-100.13 The Combined Use of Intra-Aortic Balloon Pump and Impella in Cardiogenic Shock Patients: More Is Better?

Intra-aortic balloon pump in cardiogenic shock: A propensity score matching analysis.

To assess the impact of intra-aortic balloon pumps (IABP) on patients with cardiogenic shock in an intensive care unit setting. IABP counterpulsation is a widely used mechanical circulatory support device, but its performance has been questioned. However, current evidence of IABP use in cardiogenic shock is very limited (mainly from the IABP-SHOCK II trial), which was restricted to cardiogenic shock complicating acute myocardial infarction. This was a retrospective, real-world, cohort study based on the Medical Information Mart for Intensive Care III database. Adult patients with a diagnosis of cardiogenic shock were eligible. A total of 1028 patients with cardiogenic shock were assessed, including 384 patients who received IABP and 644 patients who did not. The in-hospital mortality was significantly lower in patients who received IABP (adjusted odds ratio: 0.75, 95% confidence interval: 0.62-0.91, p = 0.009). Analysis of secondary endpoints found that the use of IABP was associated with a significantly lower risk of 1-year mortality. After propensity score matching, the in-hospital mortality remained significantly lower in the IABP group (28.10% vs. 37.59%, p = 0.018). In the current cohort, IABP treatment was associated with a lower risk of in-hospital mortality in patients with cardiogenic shock. Due to the complexity of pathophysiology in cardiogenic shock and the discrepancies in current evidence, our results should be validated through further studies in the future.

A case of perioperative IABP use in a patient with AMI complicated with VSR.

Ventricular septal rupture (VSR) following myocardial infarction may lead to rapid clinical deterioration with pulmonary edema, hypotension, and a high early mortality. Inotropic agents can increase systemic output but at the possible cost of increased myocardial ischemia. In contrast, intra-aortic balloon pump (IABP) can decrease ischemia by raising coronary perfusion pressure and will reduce afterload. We are presenting the case of a 67-year-old male presented in the emergency department with strong chest pain, diagnosed as inferior acute myocardial infarction (AMI), in TTE visualised VSR with left-to-right shunt. After a few hours, the hemodynamic parameters deteriorated, with hemodynamic instability. The patient is placed on regime with IABP on 1: 1 ratio and on high-dose inotropic drug regime. Once hemodynamic stability is ensured, the patient prepares to perform the intervention. The intervention performed was closure of the VSR with patch Dacron via ventriculotomy of the inferior wall of the left ventricle. At all times, the patient remained associated with IABP, except for extracorporeal circulation time. After the intervention, the patient remained for several days bound to IABP, until hemodynamic stability was achieved, and the dose of inotropic drugs was reduced.

A Warm Welcome to The First Issue of JSCAI

A Warm Welcome to The First Issue of JSCAI

A Comparison of In-Hospital Outcomes Between the Use of Impella and IABP in Acute Myocardial Infarction Cardiogenic Shock Undergoing Percutaneous Coronary Intervention.

The use of Impella ventricular support systems and intra-aortic balloon pump (IABP) in acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) has increased in recent years and expanded treatment options, although the comparative clinical outcomes and device safety remain unclear. We used the Nationwide Inpatient Sample database (2012-2017) to identify adults who were admitted for AMI complicated by CS and received percutaneous coronary intervention (PCI). The study sample was divided into Impella and IABP groups. Patient characteristics, hospital characteristics, and comorbidities were balanced between groups using propensity-score matching. Regression analysis was utilized to study outcome differences between groups. We identified 51,150 patients, of whom 44,265 (86.54%) received IABP and 6885 (13.46%) received Impella. After propensity matching, compared with the Impella group (n = 1592), the IABP group (n = 8638) had lower rates of sepsis (6.44% vs 12.69%; P=.01), blood transfusion (8.92% vs 14.28%; P=.01), mortality (28.95% vs 49.59%; P<.01), and hospitalization costs ($49,420 vs $68,087; P<.001). The IABP group had similar rates of cardiac arrest (20.32% vs 22.22%; P=.32), in-hospital stroke (1.46% vs 1.59%; P=.37), and length-of-stay (8.56 days vs 8.64 days; P=.26) compared with the Impella group. In patients with CS complicating AMI who underwent PCI, Impella use compared with IABP was associated with higher mortality with no differences in in-hospital stroke and cardiac arrest rates, although study interpretation is limited by retrospective observational design and the potential for remaining confounders. Further prospective research is warranted to elucidate the optimal mechanical circulatory support device in these patients.

Inclusion of interleukin-6 improved performance of postoperative delirium prediction for patients undergoing coronary artery bypass graft (POD-CABG): A derivation and validation study

BackgroundPatients undergoing coronary artery bypass graft (CABG) are at high risk for developing postoperative delirium (POD). A simple prediction rule may benefit patients from early identification of POD followed by adequate preventive strategies. The purpose of the current study was to develop and validate a POD prediction rule for patients undergoing CABG (POD-CABG), by considering all possible perioperative factors. MethodsIn this prospective cohort study, patients who underwent first elective isolated CABG were continuously enrolled from May 2014 to November 2015 in a tertiary hospital. Delirium was assessed using the Confusion Assessment Method for Intensive Care Unit. Patients’ perioperative risk factors were collected through interviews and review of medical records. The area under receiver-operating characteristic curve (AUC) was used to assess the overall performance of the predictive rule. ResultsA total of 242 and 148 patients were enrolled in the derivation and validation cohorts, respectively. Multiple logistic regression analysis identified seven variables that were independently associated with POD: age (≥65 years), gender (female), history of myocardial infarction and diabetes mellitus, postoperative atrial fibrillation, the use of intra-aortic balloon pump, and serum interleukin-6 ≥478 pg/ml at 18 hours after surgery. The AUC of the POD-CABG was 0.84 (95% CI, 0.79-0.90) in the derivation cohort, and was 0.86 (95% CI, 0.80-0.91) after bootstrap resampling. The AUC was 0.81 (95% CI, 0.73-0.88) after the POD-CABG was applied to the validation cohort. ConclusionsThe POD-CABG with inclusion of interleukin-6 demonstrated good performance in predicting POD.

Cardiogenic Shock Complicating ST-Segment Elevation Myocardial Infarction: An 18-Year Analysis of Temporal Trends, Epidemiology, Management, and Outcomes.

There are limited data on the temporal trends, incidence, and outcomes of ST-segment-elevation myocardial infarction-cardiogenic shock (STEMI-CS). Adult (>18 years) STEMI-CS admissions were identified using the National Inpatient Sample (2000-2017) and classified by tertiles of admission year (2000-2005, 2006-2011, 2012-2017). Outcomes of interest included temporal trends, acute organ failure, cardiac procedures, in-hospital mortality, hospitalization costs, and length of stay. In ∼4.3 million STEMI admissions, CS was noted in 368,820 (8.5%). STEMI-CS incidence increased from 5.8% in 2000 to 13.0% in 2017 (patient and hospital characteristics adjusted odds ratio [aOR] 2.45 [95% confidence interval {CI} 2.40-2.49]; P < 0.001). Multiorgan failure increased from 55.5% (2000-2005) to 74.3% (2012-2017). Between 2000 and 2017, coronary angiography and percutaneous coronary intervention use increased from 58.8% to 80.1% and 38.6% to 70.6%, whereas coronary artery bypass grafting decreased from 14.9% to 10.4% (all P < 0.001). Over the study period, the use of intra-aortic balloon pump (40.6%-37.6%) decreased, and both percutaneous left ventricular assist devices (0%-12.9%) and extra-corporeal membrane oxygenation (0%-2.8%) increased (all P < 0.001). In hospital mortality decreased from 49.6% in 2000 to 32.7% in 2017 (aOR 0.29 [95% CI 0.28-0.31]; P < 0.001). During the 18-year period, hospital lengths of stay decreased, hospitalization costs increased and use of durable left ventricular assist device /cardiac transplantation remained stable (P > 0.05). In the United States, incidence of CS in STEMI has increased 2.5-fold between 2000 and 2017, while in-hospital mortality has decreased during the study period. Use of coronary angiography and PCI increased during the study period.

Fulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics, Treatments, and Outcomes.

Objectives: Fulminant myocarditis (FM) is a rapidly progressive and frequently fatal form of myocarditis that has been difficult to classify. This study aims to compare the clinical characteristics, treatments and outcomes in patients with fulminant giant cell myocarditis (FGCM) and fulminant lymphocytic myocarditis (FLM).Methods and Results: In our retrospective study, nine patients with FGCM (mean age 47.9 ± 7.5 years, six female) and 7 FLM (mean age 42.1 ± 12.3 years, four female) patients confirmed by histology in the last 11 years were included. Most patients with FGCM and FLM were NYHA functional class IV (56 vs. 100%, p = 0.132). Patients with FGCM had significantly lower levels of high-sensitivity C-reactive protein [hs-CRP, 4.4 (2.0–10.2) mg/L vs. 13.6 (12.6–14.6) mg/L, P = 0.004, data shown as the median with IQR], creatine kinase-myoglobin [CK-MB, 1.4 (1.0–3.2) ng/ml vs. 14.6 (3.0–64.9) ng/ml, P = 0.025, median with IQR], and alanine aminotransferase [ALT, 38.0 (25.0–61.5) IU/L vs. 997.0 (50.0–3,080.0) IU/L, P = 0.030, median with IQR] and greater right ventricular end-diastolic diameter (RVEDD) [2.9 ± 0.3 cm vs. 2.4 ± 0.6 cm, P = 0.034, mean ± SD] than those with FLM. No differences were observed in the use of intra-aortic balloon pump (44 vs. 43%, p = 1.000) and extracorporeal membrane oxygenation (11 vs. 43%, p = 0.262) between the two groups. The long-term survival rate was significantly lower in FGCM group compared with FLM group (0 vs. 71.4%, p = 0.022). A multivariate cox regression analysis showed the level of hs-CRP (hazard ratio = 0.871, 95% confidence interval: 0.761–0.996, P = 0.043) was an independent prognostic factor for FM patients. Furthermore, the level of hs-CRP had a good ability to discriminate between patients with FGCM and FLM (AUC = 0.94, 95% confidence interval: 0.4213–0.9964).Conclusions: The inflammatory response and myocardial damage in the patients with FGCM were milder than those with FLM. Patients with FGCM had distinctly poorer prognoses compared with those with FLM. Our results suggest that hs-CRP could be a promising prognostic biomarker and a hs-CRP level of 11.71 mg/L is an appropriate cutoff point for the differentiating diagnosis between patients with FGCM and FLM.

Real world experience of intra-aortic balloon pump use and its outcome during acute myocardial infarction at tertiary care centre

Real world experience of intra-aortic balloon pump use and its outcome during acute myocardial infarction at tertiary care centre

Impact of UNOS allocation policy changes on utilization and outcomes of patients bridged to heart transplant with intra-aortic balloon pump.

Intra-aortic balloon pump (IABP) support may improve the hemodynamic profiles of patients in cardiogenic shock and bridge patients to heart transplant. In 2018, the United Network for Organ Sharing (UNOS) introduced new heart allocation criteria that increased the waitlist status of patients with IABPs to Status 2. This study assesses the impact of this change on IABP use and outcomes of patients with IABPs. We queried the UNOS database for first adult heart transplant candidates with IABPs listed or transplanted before and after the UNOS policy changes (October 18, 2016-October 17, 2018, or October 18, 2018-September 4, 2020). We compared post-transplant survival and waitlist outcomes using Kaplan-Meier and Fine-Gray analyses. Two thousand three hundred fifty-eight patients met inclusion criteria. Utilization of IABPs for hemodynamic support increased by 338% in the two years after the policy change. Patients with IABPs listed after the policy change were more likely to receive a transplant and were transplanted more quickly (p<.001). Posttransplant survival was comparable before and after the policy change (p=.056), but non-transplanted patients were more likely to be delisted post-policy change (p<.001). The UNOS allocation criteria have benefited patients bridged with an IABP, given the higher transplant rate and shorter time to transplant.

Effect of UNOS policy change and exception status request on outcomes in patients bridged to heart transplant with an intra-aortic balloon pump.

Intra-aortic balloon pumps (IABP) are used to bridge select end-stage heart disease patients to heart transplant (HT). IABP use and exception requests both increased dramatically after the UNOS policy change (PC). The purpose of this study was to evaluate the effect of PC and exception status requests on waitlist and post-transplant outcomes in patients bridged to HT with IABP support. We analyzed adult, first-time, single-organ HT recipients from the UNOS Registry either on IABP at the time of registration for HT or at the time of HT. We compared waitlist and post-HT outcomes between patients from the PRE (October 18, 2016 to May 30, 2018) and POST (October 18, 2018 to May 30, 2020) eras using Kaplan-Meier curves and time-to-event analyses. A total of 1267 patients underwent HT from IABP (261 pre-policy/1006 post-policy). On multivariate analysis, PC was associated with an increase in HT (sub-distribution hazard ratio (sdHR): 2.15, p<.001) and decrease in death/deterioration (sdHR: 0.55, p=.011) on the waitlist with no effect on 1-year post-HT survival (p=.8). The exception status of patients undergoing HT was predominantly seen in the POST era (29%, 293/1006); only four patients in the PRE era. Exception requests in the POST era did not alter patient outcomes. In patients bridged to heart transplant with an IABP, policy change is associated with decreased rates of death/deterioration and increased rates of heart transplantation on the waitlist without affecting 1-year post-transplant survival. While exception status use has markedly increased post-PC, it is not associated with patient outcomes.

Abstract 13730: In-Hospital Outcomes for Takotsubo Cardiomyopathy Among Patients With Psychiatric Diagnosis

Background: Takotsubo (or stress) cardiomyopathy (TC) is a transient regional systolic dysfunction, clinically and echocardiographically resembling acute coronary syndrome (ACS) in the absence of obstructive coronary artery disease. The prevalence of psychiatric disorders is high in TC. However, it is unclear whether presence of underlying psychiatric condition impacts outcomes of TC. Methods: Hospitalizations for TC from 2012 to 2018 were identified using the National Inpatient Sample (NIS) and stratified by presence or absence of concomitant psychiatric diagnoses (major depression, dysthymia, anxiety, bipolar, substance abuse). Outcomes of interest included mortality, cardiac arrest, cardiogenic shock, intra-aortic balloon pump (IABP), mechanical ventilation, and length of stay. Differences in outcome rates were compared using the Rao-Scott chi-square test; length of stay was compared using a lognormal regression model. All analyses accounted for the NIS sampling design. Results: A total of 51,625 hospital discharges with TC were identified, of which 21,690 (42%) carried a psychiatric diagnosis. There were no statistically significant differences in mortality (1.2% vs. 1.6%; p=0.087), cardiac arrest (1.5% vs. 1.5%; p=0.853), cardiogenic shock (4.6% vs. 4.9%; p=0.427), IABP use (1.6% vs. 1.7%; p=0.695), mechanical ventilation (4.9% vs. 4.2%; p=0.113) for patients with and without psychiatric diagnosis, respectively. The length of stay among patients with psychiatric diagnosis, was marginally higher (median 3.7, IQR [3.6-3.8] days vs. 3.5 [3.4-3.6] days; p&lt;0.01). Conclusion: Our analysis demonstrates that in-hospital mortality and complications of TC patients with and without psychiatric illness are statistically similar.

Abstract 11566: Use of Temporary Mechanical Circulatory Support Devices in Heart Failure Patients with Cardiogenic Shock

Objective: Contemporary use of temporary mechanical circulatory support devices (tMCS) for heart failure (HF) without acute myocardial infarction (AMI) is not well described. Accordingly, we evaluated use patterns for tMCS in HF patients. Methods: This was a retrospective study of a large administrative claims dataset between 01/01/06 and 12/31/19. We included patients with HF or cardiogenic shock who received tMCS i.e. Impella, intra-aortic balloon pump (IABP) or extra-corporeal membrane oxygenator (ECMO) in the absence of AMI or coronary revascularization. Multinomial logistic regression model was used to identify predictors for type of tMCS device. Temporal trends in use of tMCS was also evaluated. Results: We included 2722 HF patients receiving tMCS: 1836 (68%) with ischemic cardiomyopathy (ICM) and 886 (32%) with non-ischemic cardiomyopathy (NICM). There were no gender or racial differences in device use. Table shows adjusted odds ratio for predictors associated with receipt of ECMO or Impella compared to IABP. After multivariable adjustment, patients with ICM or NICM placed on ECMO compared to IABP, had a higher comorbidity burden. For both groups, patients with valvular disease were more likely to receive IABP and patients with peripheral vascular disease an Impella. Over time, there was an increase in Impella and ECMO use with a decrease in IABP use (p &lt;0.05; Figure). Conclusions: In a real world cohort of HF patients with cardiogenic shock without AMI, use of Impella and ECMO has increased over the last decade and IABP has decreased. Patients receiving ECMO have a higher co-morbidity burden, whereas patients receiving IABP are more likely to have valvular heart disease.

Impact of the 2018 change in US allocation policy on adults with congenital heart disease

The US adult heart allocation policy was changed on October 18, 2018. This study aims to evaluate its impact on orthotopic heart transplantation (OHT) for adults with congenital heart disease (ACHD).The United Network for Organ Sharing database was used to perform 2 comparisons: waitlist outcomes among listed ACHD candidates, and post-transplant outcomes in those transplanted. Waitlisted candidates were stratified by date of waitlisting: Period 1: 2010 to 2013; Period 2: 2014 to October 17, 2018 and Period 3: October 18, 2018 to March 20, 2020. Transplanted ACHD patients were similarly stratified but by date of transplantation. Competing risk regression for waitlist outcomes was performed. Post-transplant survival was analyzed using the Kaplan-Meier method and multivariable Cox regression.Nine hundred and seventy-six patients with ACHD were waitlisted for OHT in our study: 343(35.1%), 466(47.8%), and 167(17.1%) in periods 1, 2, and 3. Post-policy change, 1-year cumulative incidence of waitlist mortality or deterioration decreased (p = 0.02). Six hundred and forty-eight patients were transplanted: 221(34.1%), 329(50.8%) and 98(15.1%) respectively. In those transplanted, post-policy median waitlist time (174, 161 and 38 days, p < 0.001) decreased and the use of intra-aortic balloon pumps increased (1.4%, 4.9% and 19.4%, p < 0.001). Compared to periods 1 and 2, risk-adjusted post-transplant 1-year mortality was similar to period 3 (HR 1.10, 95% CI 0.52-2.32; p = 0.81) (HR 1.19, 95% CI 0.58-2.46, p = 0.63).The recent US allocation policy change may have resulted in reduced waitlist times and 1-year waitlist mortality for OHTs in ACHD patients. Early post-transplant outcomes appear comparable post-policy change.