ABSTRACT
The rising use of temporary mechanical circulatory support (tMCS) to stabilize patients with acute cardiogenic shock has resulted in an increased number of these patients being bridged to advanced therapies. While heart transplantation has become the favored path for these patients, durable VAD can be a safe option to recover these Intermacs I patients. All patients implanted with durable VAD at our center from 2017-2021 were reviewed retrospectively and included in this series. Thirty-three patients underwent VAD implantation during the study period. At the time of implant, 78.8% were INTERMACS 1 on tMCS (N=26) and 92.3% (N=24) were stabilized on an Impella (Abiomed, Danvers, MA), 3.8% (N=1) required Centrimag and 3.8% (N=1) required combined VA-ECMO and Impella. Mean age was 65.3 years, 88.4% were male and 39% (N=13) had nonischemic cardiomyopathy. Six patients were implanted with Heartmate II LVAD, while 27 received Heartmate 3 (Abbott, Abbott Park, IL). At the time of VAD implantation, 19% (n=5) of patients required RV mechanical support. Ninety-two percent of patients survived to discharge with a mean total length of stay of 56.23 days and mean post VAD length of stay 34.2 days. Sixty percent of these patients (N=15) survived at least 1-year, with 12 of the patients alive at 2 years. Of the early expirations, 80% died within the first 6 months post implant. Etiology of mortality included RV failure in 50% of patients, COVID-19 infection in 17% , and sepsis in 25%. Despite the high-risk of mortality in the cardiogenic shock population, those patients who can be stabilized with tMCS can have reasonable survival following durable VAD implantation. Following implant, the highest risk for mortality is within the first 6 months and is primarily related to worsening RV dysfunction. With recent data also showing that HM3 can extend life by 5 years, the concept of bridge to transplant LVAD should also be reconsidered for this very sick patient population. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)