Clinical Outcomes of Advanced Heart Failure Patients with Cardiogenic Shock Treated with Temporary Circulatory Support Before Durable LVAD Implant

Temporary circulatory support (TCS) is used to improve hemodynamics in patients with cardiogenic shock as a bridge to durable ventricular assist device (dVAD). Data from dVAD recipients with or without TCS (extracorporeal membranous oxygenation [ECMO], n = 14; TandemHeart [TH], n = 26) were evaluated. Clinical characteristics and hemodynamics were analyzed for patients before and after TCS and compared with profile 1 (n = 29) or profile 2-3 (n = 269) patients without TCS before dVAD. Extracorporeal membranous oxygenation patients had the highest use of preoperative mechanical ventilation, vasopressors, and the highest HeartMate II risk score before dVAD (p < 0.01). Patients receiving TCS before dVAD implant had hemodynamics comparable with patients in Profiles 2-3 and superior to that of Profile 1 patients without TCS. Operative survival after dVAD was lower in patients receiving ECMO (57%) compared with Profile 1 patients receiving TH (88%), Profile 1 without TCS (82%), or Profile 2-3 patients (97%; all p < 0.01). Despite improved clinical stability with TCS, patients bridged to a dVAD have event-free survival that parallels patients in profile 1 without TCS. Our data suggest that patients requiring TCS before dVAD implant should be still classified Interagency Registry for Mechanically Assisted Circulatory Support profile 1.