A continuous-flow external ventricular assist device for cardiogenic shock: Evolution over 10 years. Academic Article uri icon

Overview

abstract

  • BACKGROUND: The use of percutaneous mechanical circulatory support (MCS) in the treatment of cardiogenic shock has increased. However, limitations in flow capability, ventricular unloading effect, durability, and mobility remain. We reviewed our single-center experience with continuous-flow external ventricular assist devices (VADs) to determine the role of temporary VADs for cardiogenic shock in the contemporary MCS era. METHODS: We retrospectively reviewed 252 patients who underwent continuous-flow external VAD insertion between January 2007 and December 2016. To investigate the change in indications, device configurations, and outcomes, we divided the cohort into 2 groups-2007 to 2011 (Era 1; n = 127) and 2012 to 2016 (Era 2; n = 125)-and compared early and late outcomes. RESULTS: Indications and device configurations changed significantly over time. The use of preoperative percutaneous MCS (53% vs 23%; P < .01) and use of minimally invasive VAD configurations (23% vs 6.7%; P < .01) were greater in Era 2 compared with Era 1. The rate of bridge to the next destinations, including myocardial recovery, transplantation, and durable VAD, was similar in the 2 groups. In-hospital mortality was significantly better in Era 2 (50% vs 37%; P = .04). Overall survival at 1 year was 57% in Era 2 versus 43% in Era 1 (P = .04). CONCLUSIONS: Better outcomes in the recent era could be associated with the changes in practice patterns using continuous-flow external VAD in patients with refractory cardiogenic shock.

publication date

  • February 13, 2018

Research

keywords

  • Heart-Assist Devices
  • Oxygenators
  • Shock, Cardiogenic
  • Ventricular Function, Left
  • Ventricular Function, Right

Identity

Scopus Document Identifier

  • 85042717406

Digital Object Identifier (DOI)

  • 10.1016/j.jtcvs.2017.12.148

PubMed ID

  • 29510941

Additional Document Info

volume

  • 156

issue

  • 1